Circulating HIV type 1 drug resistance will have limited impact on the effectiveness of preexposure prophylaxis among young women in Zimbabwe.
BACKGROUND
Preexposure prophylaxis (PrEP) with antiretroviral drugs may prevent transmission of human immunodeficiency virus (HIV). Our objective was to predict whether PrEP, in the presence of circulating drug resistance, will reduce the risk of infection with HIV.


METHODS
We used risk equations to calculate the monthly risk of infection with HIV before and after the introduction of PrEP. Uncertainty and sensitivity analyses were performed for 2 ranges of PrEP effectiveness (40%-60% and 60%-80%). Circulating drug resistance was assumed to reduce the effectiveness of PrEP by 50%-90% and the transmissibility of HIV by 0%-30%. Parameter ranges were chosen for women 17-29 years of age from publications on HIV in Manicaland in Zimbabwe.


RESULTS
PrEP would decrease the median risk of HIV transmission by 21%-33% (effectiveness of PrEP, 40%-60% and 60%-80%). If 50% of HIV strains are drug resistant, then the median risk reduction would be 19%-26% if drug-resistant strains were less transmissible than wild-type HIV and 12%-19% if they were equally transmissible. The risk would increase if condoms were frequently replaced with PrEP. Use of PrEP for sexual acts for which no protection is currently used would be beneficial.


CONCLUSIONS
The public health impact of PrEP will depend on its effectiveness and on risk behavior. Circulating drug resistance will have only a small impact on the effectiveness of PrEP.
van de Vijver
David A M C
DA
Department of Virology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. d.vandevijver@erasmusmc.nl
Derdelinckx
Inge
I
Boucher
Charles A B
CA
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000821:virology; D018076:DNA, Complementary / Q000235:genetics; D024882:Drug Resistance, Viral; D005260:Female; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008213:Lymphocyte Activation; D009154:Mutation; D019829:Nevirapine / Q000627:therapeutic use*; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D013019:South Africa; D019562:Viral Load; D017735:Virus Latency / Q000187:drug effects*; D015030:Zimbabwe
D019380:Anti-HIV Agents; D018076:DNA, Complementary; D012367:RNA, Viral; D019829:Nevirapine