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The Effect of Oral Pre-Exposure Prophylaxis on the Progression of HIV-1 Seroconversion
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9 10 2017
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Source: AIDS. 31(14):2007-2016
[PDF-1.00 MB]
Details:
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Alternative Title:AIDS
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Personal Author:
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Description:Objective
To investigate whether oral pre-exposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection.
Design
Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda.
Methods
Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals.
Results
There was a significant increase in delayed site detection of infection associated with PrEP (OR=3.49, p=0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (OR=0.93, p=0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 days versus 17 days, p=0.05). Adjusted for Fiebig stage, viral RNA was ~2/3 log lower in those assigned to PrEP compared to placebo; no differences were found in Architect S/CO at any stage.
Conclusions
Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.
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Source:
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Pubmed ID:28692542
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Pubmed Central ID:PMC5578893
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Funding:
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Volume:31
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Issue:14
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