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. 2017 Sep 10;31(14):2007-2016.
doi: 10.1097/QAD.0000000000001577.

The effect of oral preexposure prophylaxis on the progression of HIV-1 seroconversion

Deborah Donnell  1 , Eric Ramos, Connie Celum, Jared Baeten, Joan Dragavon, Jordan Tappero, Jairam R Lingappa, Allan Ronald, Kenneth Fife, Robert W Coombs; Partners PrEP Study Team
Affiliations

The effect of oral preexposure prophylaxis on the progression of HIV-1 seroconversion

Deborah Donnell et al. AIDS. .

Abstract

Objective: To investigate whether oral preexposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection.

Design: Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda.

Methods: Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals.

Results: There was a significant increase in delayed site detection of infection associated with PrEP (odds ratio = 3.49, P = 0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (odds ratio = 0.93, P = 0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 versus 17 days, P = 0.05). Adjusted for Fiebig stage, viral RNA was ∼2/3 log lower in those assigned to PrEP compared with placebo; no differences were found in Architect signal to cut-off at any stage.

Conclusion: Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.

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Figures

Fig. 1
Fig. 1
Time between first HIV-infected sample and site detection of seroconversion (N = 129).
Fig. 2
Fig. 2
Fiebig stage observed in placebo, preexposure prophylaxis as-treated and preexposure prophylaxis with no tenofovir detected groups.
Fig. 3
Fig. 3
Architect signal to cut-off ratio is plotted for each sample by stage and arm.
See this image and copyright information in PMC

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