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Tao K, Zhou J, Nagarajan P, Tzou PL, Shafer RW. Comprehensive database of HIV mutations selected during antiretroviral in vitro passage experiments. Antiviral Res 2024; 230:105988. [PMID: 39154752 PMCID: PMC11412686 DOI: 10.1016/j.antiviral.2024.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND In vitro passage experiments are crucial to the development of antiretroviral (ARV) drugs. METHODS We created an online database containing data from 102 published studies in which HIV-1 or HIV-2 was cultured with increasing concentrations of the FDA-approved nucleoside RT inhibitors (NRTIs), nonnucleoside RT inhibitors (NNRTIs), integrase strand transfer inhibitors (INSTIs), protease inhibitors (PIs), capsid inhibitor (CAI) lenacapavir, and nucleoside RT translocation inhibitor (NRTTI) islatravir. We summarized the mutations selected in the subset of passage experiments with NRTIs lamivudine (3TC), emtricitabine (FTC), abacavir (ABC), tenofovir (TFV), and zidovudine (AZT), NNRTIs doravirine (DOR), efavirenz (EFV), and rilpivirine (RPV), INSTIs bictegravir (BIC), cabotegravir (CAB), and dolutegravir (DTG), and PIs atazanavir (ATV), darunavir (DRV), and lopinavir (LPV). Mutations selected in vitro were compared with those selected in persons receiving the same ARV. RESULTS Twenty-seven studies described 89 experiments of wildtype isolates passaged with 3TC, FTC, ABC, TFV, or AZT; sixteen studies described 89 experiments passaged with EFV, RPV, or DOR; eleven studies described 76 experiments passaged with the INSTIs BIC, CAB, or DTG; six studies described 33 experiments passaged with ATV, LPV, or DRV. With several exceptions, mutations selected in two or more experiments were among the most common mutations selected in persons receiving the same ARV. CONCLUSIONS We created a database of published ARV in vitro selection experiments. Mutations emerging from these experiments generally predict those observed in persons receiving the same ARV. However, there are notable differences in mutation frequencies between in vitro and in vivo settings.
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Affiliation(s)
- Kaiming Tao
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Jinru Zhou
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Pavithra Nagarajan
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Philip L Tzou
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, 94305, USA.
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Geretti AM, White E, Orkin C, Tostevin A, Tilston P, Chadwick D, Leen C, Sabin C, Dunn DT. Virological outcomes of boosted protease inhibitor-based first-line ART in subjects harbouring thymidine analogue-associated mutations as the sole form of transmitted drug resistance. J Antimicrob Chemother 2020; 74:746-753. [PMID: 30544247 PMCID: PMC6376847 DOI: 10.1093/jac/dky468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/06/2018] [Accepted: 10/13/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives In subjects with transmitted thymidine analogue mutations (TAMs), boosted PIs (PI/b) are often chosen to overcome possible resistance to the NRTI backbone. However, data to guide treatment selection are limited. Our aim was to obtain firmer guidance for clinical practice using real-world cohort data. Methods We analysed 1710 subjects who started a PI/b in combination with tenofovir or abacavir plus emtricitabine or lamivudine, and compared their virological outcomes with those of 4889 patients who started an NNRTI (predominantly efavirenz), according to the presence of ≥1 TAM as the sole form of transmitted drug resistance. Results Participants with ≥1 TAM comprised predominantly MSM (213 of 269, 79.2%), subjects of white ethnicity (206 of 269, 76.6%) and HIV-1 subtype B infections (234 of 269, 87.0%). Most (203 of 269, 75.5%) had singleton TAMs, commonly a revertant of T215Y or T215F (112 of 269, 41.6%). Over a median of 2.5 years of follow-up, 834 of 6599 (12.6%) subjects experienced viraemia (HIV-1 RNA >50 copies/mL). The adjusted HR for viraemia was 2.17 with PI/b versus NNRTI-based therapy (95% CI 1.88–2.51; P < 0.001). Other independent predictors of viraemia included injecting drug use, black ethnicity, higher viral load and lower CD4 cell count at baseline, and receiving abacavir instead of tenofovir. Resistance showed no overall impact (adjusted HR 0.77 with ≥1 TAM versus no resistance; 95% CI 0.54–1.10; P = 0.15). Conclusions In this cohort, patients harbouring ≥1 TAM as the sole form of transmitted drug resistance gained no apparent virological advantage from starting first-line ART with a PI/b.
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Affiliation(s)
- Anna Maria Geretti
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Ellen White
- MRC Clinical Trials Unit at University College London, London, UK
| | - Chloe Orkin
- Department of Infection & Immunity, Barts Health NHS Trust, London, UK
| | - Anna Tostevin
- Institute for Global Health, University College London, London, UK
| | - Peter Tilston
- Department of Clinical Virology, Manchester Royal Infirmary, Manchester, UK
| | - David Chadwick
- Department of Infectious Diseases, South Tees Hospitals NHS Trust, Middlesbrough, UK
| | - Clifford Leen
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
| | - David T Dunn
- Institute for Global Health, University College London, London, UK
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Alvarez M, Casas P, de Salazar A, Chueca N, Guerrero-Beltran C, Rodríguez C, Imaz A, Espinosa N, García-Bujalance S, Pérez-Elías MJ, García-Alvarez M, Iribarren JA, Santos J, Dalmau D, Aguilera A, Vinuesa D, Gutiérrez F, Piérola B, Molina JM, Peraire J, Portilla I, Gómez-Sirvent JL, Olalla J, Galera C, Blanco JR, Riera M, García-Fraile L, Navarro G, Curran A, Poveda E, García F, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Sousa LMG, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP. Surveillance of transmitted drug resistance to integrase inhibitors in Spain: implications for clinical practice. J Antimicrob Chemother 2019; 74:1693-1700. [DOI: 10.1093/jac/dkz067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marta Alvarez
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Paz Casas
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Adolfo de Salazar
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Natalia Chueca
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Carlos Guerrero-Beltran
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | | | - Arkaitz Imaz
- Unidad de VIH e ITS, Departamento de Enfermedades Infecciosas, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Espinosa
- Unidad de Enfermedades Infecciosas, Hospital Virgen del Rocio, Sevilla, Spain
| | | | | | - Mónica García-Alvarez
- Unidad de Microbiología Clínica, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Jose Antonio Iribarren
- Unidad de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto BioDonostia, Donostia, Spain
| | - Jesús Santos
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - David Dalmau
- Unidad de Enfermedades Infecciosas, Hospital Universitario Mutua Terrasa, Terrasa, Spain
| | - Antonio Aguilera
- Servicio y Departamento de Microbiología, Complejo Hospitalario Universitario de Santiago y Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - David Vinuesa
- Unidad de Enfermedades Infecciosas, Hospital Universitario, Universitario San Cecilio, Granada, Spain
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Beatriz Piérola
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José Miguel Molina
- Unidad de Microbiología Clínica, Hospital Universitario La Fe, Valencia, Spain
| | - Joaquim Peraire
- Unidad de Enfermedades Infecciosas, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Irene Portilla
- Unidad de Enfermedades Infecciosas, Hospital Universitario Alicante, Alicante, Spain
| | - Juan Luis Gómez-Sirvent
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Julián Olalla
- Unidad de Enfermedades Infecciosas, Hospital Costa del Sol, Marbella, Spain
| | - Carlos Galera
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José Ramón Blanco
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, Spain
| | - Melchor Riera
- Unidad de Enfermedades Infecciosas, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Lucio García-Fraile
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Princesa, Madrid, Spain
| | - Gemma Navarro
- Unidad de Enfermedades Infecciosas, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - Adrían Curran
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Federico García
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
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Lebbink RJ, de Jong DCM, Wolters F, Kruse EM, van Ham PM, Wiertz EJHJ, Nijhuis M. A combinational CRISPR/Cas9 gene-editing approach can halt HIV replication and prevent viral escape. Sci Rep 2017; 7:41968. [PMID: 28176813 PMCID: PMC5296774 DOI: 10.1038/srep41968] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/30/2016] [Indexed: 01/05/2023] Open
Abstract
HIV presents one of the highest evolutionary rates ever detected and combination antiretroviral therapy is needed to overcome the plasticity of the virus population and control viral replication. Conventional treatments lack the ability to clear the latent reservoir, which remains the major obstacle towards a cure. Novel strategies, such as CRISPR/Cas9 gRNA-based genome-editing, can permanently disrupt the HIV genome. However, HIV genome-editing may accelerate viral escape, questioning the feasibility of the approach. Here, we demonstrate that CRISPR/Cas9 targeting of single HIV loci, only partially inhibits HIV replication and facilitates rapid viral escape at the target site. A combinatorial approach of two strong gRNAs targeting different regions of the HIV genome can completely abrogate viral replication and prevent viral escape. Our data shows that the accelerating effect of gene-editing on viral escape can be overcome and as such gene-editing may provide a future alternative for control of HIV-infection.
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Affiliation(s)
- Robert Jan Lebbink
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien C. M. de Jong
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke Wolters
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth M. Kruse
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M. van Ham
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emmanuel J. H. J. Wiertz
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique Nijhuis
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, The Netherlands
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Mzingwane ML, Tiemessen CT, Richter KL, Mayaphi SH, Hunt G, Bowyer SM. Pre-treatment minority HIV-1 drug resistance mutations and long term virological outcomes: is prediction possible? Virol J 2016; 13:170. [PMID: 27733203 PMCID: PMC5062819 DOI: 10.1186/s12985-016-0628-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although the use of highly active antiretroviral therapy in HIV positive individuals has proved to be effective in suppressing the virus to below detection limits of commonly used assays, virological failure associated with drug resistance is still a major challenge in some settings. The prevalence and effect of pre-treatment resistance associated variants on virological outcomes may also be underestimated because of reliance on conventional population sequencing data which excludes minority species. We investigated long term virological outcomes and the prevalence and pattern of pre-treatment minority drug resistance mutations in individuals initiating HAART at a local HIV clinic. Methods Patient’s records of viral load results and CD4 cell counts from routine treatment monitoring were used and additional pre-treatment blood samples for Sanger sequencing were obtained. A selection of pre-treatment samples from individuals who experienced virological failure were evaluated for minority resistance associated mutations to 1 % prevalence and compared to individuals who achieved viral suppression. Results At least one viral load result after 6 months or more of treatment was available for 65 out of 78 individuals followed for up to 33 months. Twenty (30.8 %) of the 65 individuals had detectable viremia and eight (12.3 %) of them had virological failure (viral load > 1000 RNA copies/ml) after at least 6 months of HAART. Viral suppression, achieved by month 8 to month 13, was followed by low level viremia in 10.8 % of patients and virological failure in one patient after month 20. There was potentially reduced activity to Emtricitabine or Tenofovir in three out of the eight cases in which minority drug resistance associated variants were investigated but detectable viremia occurred in one of these cases while the activity of Efavirenz was generally reduced in all the eight cases. Conclusions Early viral suppression was followed by low level viremia for some patients which may be an indication of failure to sustain viral suppression over time. The low level viremia may also be representing early stages of resistance development. The mutation patterns detected in the minority variants showed potential reduced drug sensitivity which highlights their potential to dominate after treatment initiation. Trial registration Not applicable. Electronic supplementary material The online version of this article (doi:10.1186/s12985-016-0628-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M L Mzingwane
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa. .,Department of Pathology, National University of Science & Technology, Faculty of Medicine, P. O Box AC939, Ascot, Bulawayo, Zimbabwe.
| | - C T Tiemessen
- Centre for HIV and Sexually Transmitted Infections, National Institute of communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K L Richter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa.,National Health Laboratory Services Tswane Academic Division, Pretoria, South Africa
| | - S H Mayaphi
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa.,National Health Laboratory Services Tswane Academic Division, Pretoria, South Africa
| | - G Hunt
- Centre for HIV and Sexually Transmitted Infections, National Institute of communicable Diseases, Johannesburg, South Africa
| | - S M Bowyer
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa.,National Health Laboratory Services Tswane Academic Division, Pretoria, South Africa
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Sayan M, Sargin F, Inan D, Sevgi DY, Celikbas AK, Yasar K, Kaptan F, Kutlu S, Fisgin NT, Inci A, Ceran N, Karaoglan I, Cagatay A, Celen MK, Koruk ST, Ceylan B, Yildirmak T, Akalın H, Korten V, Willke A. HIV-1 Transmitted Drug Resistance Mutations in Newly Diagnosed Antiretroviral-Naive Patients in Turkey. AIDS Res Hum Retroviruses 2016; 32:26-31. [PMID: 26414663 PMCID: PMC4692107 DOI: 10.1089/aid.2015.0110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 replication is rapid and highly error-prone. Transmission of a drug-resistant HIV-1 strain is possible and occurs within the HIV-1-infected population. In this study, we aimed to determine the prevalence of transmitted drug resistance mutations (TDRMs) in 1,306 newly diagnosed untreated HIV-1-infected patients from 21 cities across six regions of Turkey between 2010 and 2015. TDRMs were identified according to the criteria provided by the World Health Organization's 2009 list of surveillance drug resistance mutations. The HIV-1 TDRM prevalence was 10.1% (133/1,306) in Turkey. Primary drug resistance mutations (K65R, M184V) and thymidine analogue-associated mutations (TAMs) were evaluated together as nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. NRTI TDRMs were found in 8.1% (107/1,306) of patients. However, TAMs were divided into three categories and M41L, L210W, and T215Y mutations were found for TAM1 in 97 (7.4%) patients, D67N, K70R, K219E/Q/N/R, T215F, and T215C/D/S mutations were detected for TAM2 in 52 (3.9%) patients, and M41L + K219N and M41L + T215C/D/S mutations were detected for the TAM1 + TAM2 profile in 22 (1.7%) patients, respectively. Nonnucleoside reverse transcriptase inhibitor-associated TDRMs were detected in 3.3% (44/1,306) of patients (L100I, K101E/P, K103N/S, V179F, Y188H/L/M, Y181I/C, and G190A/E/S) and TDRMs to protease inhibitors were detected in 2.3% (30/1,306) of patients (M46L, I50V, I54V, Q58E, L76V, V82A/C/L/T, N83D, I84V, and L90M). In conclusion, long-term and large-scale monitoring of regional levels of HIV-1 TDRMs informs treatment guidelines and provides feedback on the success of HIV-1 prevention and treatment efforts.
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Affiliation(s)
- Murat Sayan
- Faculty of Medicine, Clinical Laboratory, PCR Unit, University of Kocaeli, Kocaeli, Turkey
- Research Center of Experimental Health Sciences, University of Near East, Nicosia, Northern Cyprus
| | - Fatma Sargin
- Goztepe Educational and Research Hospital, Clinic of Infectious Diseases, Medeniyet University, Istanbul, Turkey
| | - Dilara Inan
- Faculty of Medicine, Department of Infectious Diseases, University of Akdeniz, Antalya, Turkey
| | - Dilek Y. Sevgi
- Educational and Research Hospital, Clinic of Infectious Diseases, Sisli Etfal, Istanbul, Turkey
| | - Aysel K. Celikbas
- Educational and Research Hospital, Clinic of Infectious Diseases, Ankara Numune, Ankara, Turkey
| | - Kadriye Yasar
- Educational and Research Hospital, Clinic of Infectious Diseases, Bakırkoy Dr. Sadi Konuk, Istanbul,Turkey
| | - Figen Kaptan
- Educational and Research Hospital, Department of Infectious Diseases, University of Katip Celebi, İzmir, Turkey
| | - Selda Kutlu
- Faculty of Medicine, Department of Infectious Diseases, University of Pamukkale, Denizli, Turkey
| | - Nuriye T. Fisgin
- Faculty of Medicine, Department of Infectious Diseases, University of 19 Mayıs, Samsun, Turkey
| | - Ayse Inci
- Educational and Research Hospital, Clinic of Infectious Diseases, Istanbul Kanuni Sultan Süleyman, Istanbul, Turkey
| | - Nurgul Ceran
- Educational and Research Hospital, Clinic of Infectious Diseases, Haydarpasa Numune, Istanbul, Turkey
| | - Ilkay Karaoglan
- Faculty of Medicine, Department of Infectious Diseases, University of Gaziantep, Gaziantep, Turkey
| | - Atahan Cagatay
- Faculty of Medicine, Department of Infectious Diseases, University of Istanbul, Istanbul, Turkey
| | - Mustafa K. Celen
- Faculty of Medicine, Department of Infectious Diseases, University of Dicle, Diyarbakır, Turkey
| | - Suda T. Koruk
- Faculty of Medicine, Department of Infectious Diseases, University of Harran, Urfa, Turkey
| | - Bahadir Ceylan
- Faculty of Medicine, Department of Infectious Diseases, University of Bezm-i Alem, Istanbul, Turkey
| | - Taner Yildirmak
- Educational and Research Hospital, Clinic of Infectious Diseases, Istanbul Okmeydani, Istanbul, Turkey
| | - Halis Akalın
- Faculty of Medicine, Department of Infectious Diseases, University of Uludag, Bursa, Turkey
| | - Volkan Korten
- Faculty of Medicine, Department of Infectious Diseases, University of Marmara, Istanbul, Turkey
| | - Ayse Willke
- Faculty of Medicine, Department of Infectious Diseases, University of Kocaeli, Kocaeli, Turkey
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Krakower DS, Mayer KH. Pre-exposure prophylaxis to prevent HIV infection: current status, future opportunities and challenges. Drugs 2015; 75:243-51. [PMID: 25673022 DOI: 10.1007/s40265-015-0355-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
As the global incidence of HIV exceeds 2 million new infections annually, effective interventions to decrease HIV transmission are needed. Randomized, placebo-controlled studies have demonstrated that daily oral antiretroviral pre-exposure prophylaxis (PrEP) with a fixed-dose combination tablet containing tenofovir disoproxil fumarate and emtricitabine can significantly reduce HIV incidence among diverse at-risk populations. In these studies, the efficacy of PrEP was correlated with levels of adherence. Official guidelines recommend provision of PrEP to people at greatest risk of HIV acquisition, and demonstration projects suggest that high levels of uptake and adherence are possible outside of controlled studies. However, several potential barriers to implementing PrEP remain. These challenges include low awareness and utilization of PrEP by at-risk individuals, uncertainty about adherence in 'real-world' settings, the majority of healthcare providers being untrained in PrEP provision, limited data about potential adverse effects from long-term use of tenofovir-emtricitabine, high costs of PrEP medications, and stigma associated with PrEP use and the behaviors that would warrant PrEP. Innovative pharmacologic chemoprophylactic approaches could provide solutions to some of these challenges. Less-than-daily oral dosing regimens and long-acting injectable medications could reduce pill burdens and facilitate adherence, and local delivery of PrEP medications to genital compartments via gels, rings and films may limit systemic drug exposure and potential toxicities. As the portfolio of chemoprophylactic agents and delivery systems expands to meet the diverse sexual health needs and product preferences of individuals who may benefit from PrEP, it is hoped that antiretroviral chemoprophylaxis could become an acceptable, feasible, and highly effective addition to existing HIV prevention strategies.
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Affiliation(s)
- Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite GB, Boston, MA, 02215-5501, USA,
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