In recent years, we’ve seen big improvements in HIV prevention and treatment, especially with the rollout of HIV pre-exposure prophylaxis (PrEP). NSW has one of the highest rates of PrEP use in the world, which has helped reduce HIV transmission, especially among Australian-born gay and bisexual men. However, there are concerns that high PrEP use might lead to HIV drug resistance. To address these concerns, we recently studied the prevalence of HIV drug resistance among newly diagnosed HIV-positive men who have sex with men (MSM) in New South Wales. Specifically, our study, based at The Kirby Institute, University of New South Wales, looked at the resistance to key antiretroviral drugs used in PrEP, including tenofovir (TFV) and lamivudine/emtricitabine (XTC), among men newly diagnosed with HIV.
In our study, we analysed HIV drug resistance data linked to HIV diagnosis records from 2015 to 2021 and focused on resistance data obtained within three months post-diagnosis to capture transmitted drug resistance. The results were categorised by various factors, including year of sequencing, region of birth, likely place of HIV acquisition, and stage of HIV at diagnosis.
Among 1119 diagnoses linked to HIV drug resistance data, we found that over the study period, XTC resistance prevalence fluctuated between 0.5% and 2.9%, with no discernible change between before and after the large scale-up in NSW PrEP use, beginning with the PrEP implementation trials in 2016. Importantly, no TFV resistance was detected in any of the sequences analysed.
The findings of this study are encouraging, indicating that the prevalence of drug resistance remains low despite high PrEP use and suggests that the scale-up of PrEP in high-income settings like NSW can continue without jeopardising the treatment of those living with HIV.
While the study’s results are promising, continuous monitoring of drug resistance is crucial. The dynamic nature of HIV and the potential for resistance development means that ongoing vigilance is necessary. We must remain proactive in adapting strategies to maintain prevention and treatment efforts.
Moreover, our study highlights the importance of comprehensive data collection and analysis in understanding the impact of PrEP on HIV drug resistance. By maintaining robust surveillance systems, we can better anticipate and respond to emerging challenges in HIV prevention and treatment. Also, our study underscores the importance of evidence-based approaches and the need for ongoing research to address emerging challenges. As we move forward, sustained monitoring and adaptive strategies will be key to maintaining the effectiveness of both PrEP and HIV treatment. By staying informed and proactive, we can work towards a future where levels of HIV transmission continue to reduce, and those living with HIV receive the best possible health outcomes.
View the full research paper here: Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use