Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Preexposure prophylaxis (PrEP) with tenofovir and emtricitabine can prevent new HIV-1 infections, but there is a concern that use of PrEP could increase HIV drug resistance resulting in loss of treatment options. We compared standardized outcomes from three independent mathematical models simulating the impact of PrEP on HIV transmission and drug resistance in sub-Saharan African countries.All models assume that people using PrEP receive an HIV test every 3-6 months. The models vary in structure and parameter choices for PrEP coverage, effectiveness of PrEP (at different adherence levels) and the rate with which HIV drug resistance emerges and is transmitted.The models predict that the use of PrEP in conjunction with antiretroviral therapy will result in a lower prevalence of HIV than when only antiretroviral therapy is used. With or without PrEP, all models suggest that HIV drug resistance will increase over the next 20 years due to antiretroviral therapy. PrEP will increase the absolute prevalence of drug resistance in the total population by less than 0.5% and amongst infected individuals by at most 7%. Twenty years after the introduction of PrEP, the majority of drug-resistant infections is due to antiretroviral therapy (50-63% across models), whereas 40-50% will be due to transmission of drug resistance, and less than 4% to the use of PrEP.HIV drug resistance resulting from antiretroviral therapy is predicted to far exceed that resulting from PrEP. Concern over drug resistance should not be a reason to limit the use of PrEP.

Original publication

DOI

10.1097/01.aids.0000433237.63560.20

Type

Journal article

Journal

Aids (london, england)

Publication Date

11/2013

Volume

27

Pages

2943 - 2951

Addresses

aDepartment of Virology, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands bDepartments of Infectious Diseases and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA cDepartment of Infection and Population Health, University College London dDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK eDivision of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA fPharmAccess Foundation and Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.

Keywords

Humans, HIV-1, HIV Infections, Adenine, Deoxycytidine, Anti-HIV Agents, Drug Resistance, Viral, Models, Theoretical, Adolescent, Adult, Aged, Middle Aged, Africa South of the Sahara, Female, Male, Young Adult, Organophosphonates, Pre-Exposure Prophylaxis, Tenofovir, Emtricitabine