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Wild-type HIV infection despite PrEP: a lot to learn from a case report–Authors' reply

Abstract:

We read with interest the case report by Hoornenborg and colleagues1 about the acquisition of wild-type HIV-1 infection in a patient on pre-exposure prophylaxis (PrEP) despite high intracellular concentrations of tenofovir diphosphate. This case is all the more important given that PrEP roll-out is a work in progress, with regulatory approvals for its use for HIV prevention completed in 15 countries and dossiers under review in many others. 2 Despite its well demonstrated efficacy for the prevention of HIV acquisition, 3 PrEP’s widespred uptake means that this particular and unprecedented event might happen again. After seroconversion in the reported case, health-care workers decided to interrupt PrEP but not to start combination antiretroviral therapy (ART) because of the un certainty on an actual infection. The atypical seroconversion pattern, with initially only gp160 detected in the western blot, contributed to …