Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form
D-Scholarship @ Pitt Banner and Links to Homepage

Factors influencing the emergence and spread of HIV drug resistance arising from rollout of antiretroviral pre-exposure prophylaxis (PrEP)

Abbas, UL and Hood, G and Wetzel, AW and Mellors, JW (2011) Factors influencing the emergence and spread of HIV drug resistance arising from rollout of antiretroviral pre-exposure prophylaxis (PrEP). PLoS ONE, 6 (4).

[img]
Preview
 PDF
Published Version
Available under License : See the attached license file.
Download (639kB) | Preview
[img] Plain Text (licence)
Available under License : See the attached license file.
Download (1kB)

Abstract

Background: The potential for emergence and spread of HIV drug resistance from rollout of antiretroviral (ARV) pre-exposure prophylaxis (PrEP) is an important public health concern. We investigated determinants of HIV drug resistance prevalence after PrEP implementation through mathematical modeling. Methodology: A model incorporating heterogeneity in age, gender, sexual activity, HIV infection status, stage of disease, PrEP coverage/discontinuation, and HIV drug susceptibility, was designed to simulate the impact of PrEP on HIV prevention and drug resistance in a sub-Saharan epidemic. Principal Findings: Analyses suggest that the prevalence of HIV drug resistance is influenced most by the extent and duration of inadvertent PrEP use in individuals already infected with HIV. Other key factors affecting drug resistance prevalence include the persistence time of transmitted resistance and the duration of inadvertent PrEP use in individuals who become infected on PrEP. From uncertainty analysis, the median overall prevalence of drug resistance at 10 years was predicted to be 9.2% (interquartile range 6.9%-12.2%). An optimistic scenario of 75% PrEP efficacy, 60% coverage of the susceptible population, and 5% inadvertent PrEP use predicts a rise in HIV drug resistance prevalence to only 2.5% after 10 years. By contrast, in a pessimistic scenario of 25% PrEP efficacy, 15% population coverage, and 25% inadvertent PrEP use, resistance prevalence increased to over 40%. Conclusions: Inadvertent PrEP use in previously-infected individuals is the major determinant of HIV drug resistance prevalence arising from PrEP. Both the rate and duration of inadvertent PrEP use are key factors. PrEP rollout programs should include routine monitoring of HIV infection status to limit the spread of drug resistance. © 2011 Abbas et al.

Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Abbas, UL
Hood, G
Wetzel, AW
Mellors, JWjwm1@pitt.eduJWM1
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorMaartens, GaryUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 25 April 2011
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 6
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0018165
Schools and Programs: School of Medicine > Infectious Diseases and Microbiology
Refereed: Yes
MeSH Headings: Anti-HIV Agents--pharmacology; Drug Resistance, Viral--drug effects; HIV--drug effects; HIV Infections--prevention & control; HIV Infections--transmission; HIV Infections--virology; Humans; Treatment Outcome; Uncertainty
Other ID: NLM PMC3078109
PubMed Central ID: PMC3078109
PubMed ID: 21525976
Date Deposited: 29 Aug 2012 21:13
Last Modified: 02 Feb 2019 16:55
URI: http://d-scholarship.pitt.edu/id/eprint/13827

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com

Actions (login required)

View Item View Item