First Case of HIV Seroconversion With Integrase Resistance Mutations on Long-Acting Cabotegravir for Prevention in Routine Care
Rattachement africain : us, Kenya. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
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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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- First Case of HIV Seroconversion With Integrase Resistance Mutations on Long-Acting Cabotegravir for Prevention in Routine Care
- Date Crossref
- 26/08/2024
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of California pays non établi dans la noticeUniversité ou école supérieure
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University of San Francisco pays non établi dans la noticeUniversité ou école supérieure
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University of Pittsburgh pays non établi dans la noticeUniversité ou école supérieure
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Partners for Health and Development in Africa Kenya (code pays fourni par la source)Organisation à but non lucratif
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University of Washington pays non établi dans la noticeUniversité ou école supérieure
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Kenya Medical Research Institute Centre for Microbiology Research Nairobi, Kenya (code pays fourni par la source)Structure de recherche
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Washington University in St. Louis pays non établi dans la noticeUniversité ou école supérieure
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Whitman-Walker Health pays non établi dans la noticeÉtablissement de santé
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Men's Health Foundation pays non établi dans la noticeOrganisation à but non lucratif
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Global Programs for Research and Training Nairobi, Kenya (pays nommé en fin d’affiliation)Institution
University of California, University of San Francisco et University of Pittsburgh, avec 7 autres affiliations. Pays d’affiliation : Kenya.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.