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Case Reports
. 2023 Sep 1;37(11):1711-1714.
doi: 10.1097/QAD.0000000000003644. Epub 2023 Jul 3.

Breakthrough HIV-1 infection in setting of cabotegravir for HIV pre-exposure prophylaxis

Aniruddha Hazra  1   2 , Raphael J Landovitz  3 , Mark A Marzinke  4 , Connor Quinby  1 , Catherine Creticos  1
Affiliations
Case Reports

Breakthrough HIV-1 infection in setting of cabotegravir for HIV pre-exposure prophylaxis

Aniruddha Hazra et al. AIDS. .

Abstract

Objective: We describe the first case of HIV-1 infection in the setting of long-acting injectable cabotegravir (CAB-LA) for HIV pre-exposure prophylaxis to occur in the real world.

Design: Case report.

Methods: Electronic medical records were reviewed to assess patient history and CAB-LA administration details. Plasma fourth-generation HIV-1/2 Ag/Ab combination immunoassay and HIV-1 RNA quantitative PCR were performed at each injection visit.

Results: We report a 28-year-old sex-diverse person assigned male at birth who acquired HIV-1 infection 91 days after transitioning from tenofovir alafenamideemtricitabine to CAB-LA despite on-time dosing and appropriate laboratory monitoring.

Conclusion: This patient's history suggests HIV infection despite on-time and appropriate CAB-LA injections. To our knowledge, this is the first case of CAB-LA pre-exposure prophylaxis failure outside the setting of a clinical trial and highlights diagnostic and management challenges that may occur with such breakthrough infections.

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References

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    1. Delany-Moretlwe S, Hughes JP, Bock P, Ouma SG, Hunidzarira P, Kalonji D, et al. HPTN 084 Study Group. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial . Lancet 2022; 399:1779–1789.
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