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Koss CA, Gandhi M, Halvas EK, Okochi H, Chu C, Glidden DV, Georgetti Gomez L, Heaps AL, Conroy AA, Tran M, Shetler C, Hoeth D, Kuncze K, Louie A, Rivera Garza H, Wafula Mugoma E, Penrose KJ, Chohan BH, Ayieko JO, Mills A, Patel RR, Mellors JW, Parikh UM. First Case of HIV Seroconversion With Integrase Resistance Mutations on Long-Acting Cabotegravir for Prevention in Routine Care. Open Forum Infect Dis 2024; 11:ofae468. [PMID: 39229286 PMCID: PMC11370791 DOI: 10.1093/ofid/ofae468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/21/2024] [Indexed: 09/05/2024] Open
Abstract
Background Long-acting cabotegravir (CAB-LA) is highly effective for HIV prevention, but delayed HIV diagnoses and integrase strand transfer inhibitor (INSTI) resistance were observed in trials. We report the first case in routine clinical care of HIV infection on CAB-LA with INSTI resistance. Methods The SeroPrEP study enrolls individuals in the United States who acquire HIV on pre-exposure prophylaxis modalities to assess diagnostics, antiretroviral (ARV) drug levels, resistance, and treatment outcomes. Resistance mutations in full-length HIV-1 integrase were identified by single-genome sequencing (SGS). Cabotegravir concentrations in plasma and hair segments were measured by liquid chromatography-tandem mass spectrometry. Results A 23-year-old gender-nonbinary person, male at birth, restarted CAB-LA 6 months after discontinuation due to losing insurance. Prior to restart, HIV-1 RNA was not detected, but 20 days elapsed before CAB-LA injection. After the second CAB-LA injection, HIV antigen/antibody returned reactive (HIV-1 RNA 451 copies/mL). SGS of plasma HIV-1 RNA identified INSTI mutation Q148R in 2/24 sequences 2 days postdiagnosis; commercial genotype failed amplification. Cabotegravir hair concentration was 0.190 ng/mg 2 weeks prediagnosis; plasma cabotegravir was high (3.37 μg/mL; ∼20× PA-IC90) 14 days postdiagnosis. Viral suppression was maintained for 6 months on darunavir/cobicistat/emtricitabine/tenofovir alafenamide, then switched to doravirine + emtricitabine/tenofovir alafenamide due to nausea. Conclusions In this first case of HIV infection on CAB-LA with INSTI resistance in routine care, cabotegravir resistance was detected only with a sensitive research assay. Accelerated pathways to minimize time between HIV testing and CAB-LA initiation are needed to optimize acute HIV detection and mitigate resistance risk. Sustained product access regardless of insurance is imperative to reduce HIV infections on CAB-LA.
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Affiliation(s)
- Catherine A Koss
- University of California, San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- University of California, San Francisco, San Francisco, California, USA
| | | | - Hideaki Okochi
- University of California, San Francisco, San Francisco, California, USA
| | - Carolyn Chu
- University of California, San Francisco, San Francisco, California, USA
| | - David V Glidden
- University of California, San Francisco, San Francisco, California, USA
| | | | - Amy L Heaps
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy A Conroy
- University of California, San Francisco, San Francisco, California, USA
| | - Michael Tran
- Men's Health Foundation, Los Angeles, California, USA
| | - Cory Shetler
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dianna Hoeth
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen Kuncze
- University of California, San Francisco, San Francisco, California, USA
| | - Alexander Louie
- University of California, San Francisco, San Francisco, California, USA
| | - Hana Rivera Garza
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - James O Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anthony Mills
- Men's Health Foundation, Los Angeles, California, USA
| | - Rupa R Patel
- Whitman Walker Health, Washington DC, USA
- Washington University, St. Louis, Missouri, USA
| | | | - Urvi M Parikh
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Owens C, Stukenberg J, Grant MJ, Hoffman M. Primary Care Providers' Information Needs for Prescribing Adolescents HIV Pre-Exposure Prophylaxis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:484-494. [PMID: 38096453 DOI: 10.1521/aeap.2023.35.6.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Although knowledge is a salient determinant in primary care providers (PCPs) prescribing HIV pre-exposure prophylaxis (PrEP) to adolescents, we know little about what information PCPs want about PrEP. We conducted an online mixed-method study to explore the PrEP information needs of a national sample of 351 PCPs. We analyzed data with deductive content analysis and compared themes between respondents who were aware and not aware of PrEP, knowledgeable and not knowledgeable of the prescribing guidelines, and prescribed and never prescribed PrEP to an adolescent. PCPs who were unknowledgeable about PrEP and never prescribed PrEP to an adolescent mentioned manufacturing information, indications and dosing, and contraindications and adverse reactions more so than PCPs who were aware of and prescribed PrEP. A better understanding of the information needs of PCPs could inform provider education interventions. Future research must examine the facilitators and barriers to integrating PrEP information into medical education and clinical settings.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University
| | - Jacob Stukenberg
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
| | - Morgan J Grant
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University
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Owens C, Gray SJ, Carter K, Hoffman M, Mullen C, Hubach RD. Implementation Facilitators and Barriers for Primary Care Providers Prescribing Daily Oral PrEP to Adolescents in the United States. AIDS Patient Care STDS 2023; 37:379-393. [PMID: 37566536 DOI: 10.1089/apc.2023.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Primary care providers (PCPs) are critical in prescribing human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) to adolescents at risk of HIV. More research is needed to identify facilitators and barriers PCPs encounter in prescribing PrEP to eligible adolescents post-Food and Drug Administration (FDA) approval. This online cross-sectional survey examined the PrEP implementation facilitators and barriers among a national sample of PCPs in the United States. PCPs (n = 502) specializing in family medicine or pediatrics were recruited from a Qualtrics panel from July 15 to August 9, 2022. We analyzed the collected data using content analysis and applied the Expert Recommendations for Implementing Change (ERIC) to codebook creation and data analysis. We conducted a Fisher's exact chi-square test of independence to compare facilitator and barrier prevalence differences between participants who had and had not prescribed PrEP to an adolescent patient. Results demonstrate that (1) distributing prescriber-focused educational materials, (2) involving parents, (3) changing liability laws, (4) enhancing adolescent PrEP uptake and adherence, (5) changing clinical resources, and (6) using mass/social media to change community norms might be strategies that influence PCPs prescribing PrEP to eligible adolescent patients. Results from this study could facilitate the planning of hybrid implementation-effectiveness trials designed to determine the acceptability, feasibility, and effectiveness of implementation strategies in improving the practices of PCPs prescribing PrEP to at-risk adolescents.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Samuel J Gray
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Kaileigh Carter
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Matt Hoffman
- School of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Cody Mullen
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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