HIV drug resistance surveillance in countries scaling up pre-exposure prophylaxis, 2nd ed
The WHO recommends PrEP as a preventative option for individuals at high risk of HIV infection. While HIV drug resistance shouldn't hinder PrEP use, occasional cases have been reported in PrEP users who tested positive for HIV. This resistance could reduce the effectiveness of future treatments. Therefore, the WHO advises monitoring HIV drug resistance alongside PrEP implementation.
This guidance outlines how to track the prevalence of HIV drug resistance among PrEP users who test positive, covering various PrEP options like oral tenofovir, the dapivirine vaginal ring, and long-acting injectable cabotegravir. The monitoring results will document resistance and inform the management of individuals who test positive after PrEP use. The monitoring approach will also adapt to new PrEP regimens in the future.
HIV infection is expected to be uncommon among PrEP users. The proposed surveillance method involves a census of all HIV-positive individuals with prior PrEP exposure at participating sites (up to 250 people per PrEP regimen) over 12 months. Passive surveillance will be used, collecting data and blood samples for resistance testing, which will be analyzed in WHO-designated labs using the Stanford HIVdb algorithm. Countries are encouraged to use the WHO database for data management. The primary goal is to determine the prevalence of drug resistance in PrEP users who contract HIV. The analysis will account for genotyping failure rates across different sites to minimize bias.
Countries with national resistance testing policies should analyze data annually. Those without such policies should implement this survey every three years.
Key updates in the second edition include guidance for DVR and CAB-LA, the inclusion of participants from ART clinics, and the applicability of the method to other future PrEP regimens.
Please refer to the following link for the full article: HIV drug resistance surveillance in countries scaling up pre-exposure prophylaxis – Second edition