Use of Drug-level Testing and Single-genome Sequencing to Unravel a Case of Human Immunodeficiency Virus Seroconversion on Pre-exposure Prophylaxis

Matthew A Spinelli; Brentton Lowery; Jennifer A Shuford; Jon Spindler; Mary F Kearney; Jenny R McFarlane; Cheryl McDonald; Hideaki Okochi; Nhi Phung; Karen Kuncze; Kathryn Jee; DeeJay Johannessen; Peter L Anderson; Dawn K Smith; Patricia Defechereux; Robert M Grant; Monica Gandhi

doi:10.1093/cid/ciaa1011

Use of Drug-level Testing and Single-genome Sequencing to Unravel a Case of Human Immunodeficiency Virus Seroconversion on Pre-exposure Prophylaxis

Clin Infect Dis. 2021 Jun 1;72(11):2025-2028. doi: 10.1093/cid/ciaa1011.

Authors

Matthew A Spinelli¹, Brentton Lowery², Jennifer A Shuford³, Jon Spindler⁴, Mary F Kearney⁴, Jenny R McFarlane³, Cheryl McDonald⁵, Hideaki Okochi¹, Nhi Phung¹, Karen Kuncze¹, Kathryn Jee⁶, DeeJay Johannessen², Peter L Anderson⁷, Dawn K Smith⁸, Patricia Defechereux⁶, Robert M Grant⁶, Monica Gandhi¹

Affiliations

¹ Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
² Health Education Learning Project, Ft. Worth, Texas, USA.
³ Texas Department of State Health Services, Austin, Texas, USA.
⁴ Human Immunodeficiency Virus Dynamics and Replication Program, National Cancer Institute/National Institutes of Health, Ft. Worth, Texas, USA.
⁵ Texas Centers for Infectious Disease Associates, Ft. Worth, Texas, USA.
⁶ Division of Pulmonary Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
⁷ Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA.
⁸ Division of Human Immunodeficiency Virus/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Abstract

Cases of seroconversion on pre-exposure prophylaxis (PrEP) should be carefully investigated, given their public health implications and rarity. We report a case of transmitted drug resistance causing seroconversion on PrEP in spite of high adherence, confirmed with dried blood spot and segmental hair drug-level testing and single-genome sequencing.

Keywords: HIV seroconversion; PrEP; PrEP failure; adherence; single-genome-sequencing.

Publication types

Case Reports
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

MeSH terms

Anti-HIV Agents* / therapeutic use
Emtricitabine / therapeutic use
HIV
HIV Infections* / drug therapy
Humans
Medication Adherence
Pharmaceutical Preparations*
Pre-Exposure Prophylaxis*
Seroconversion
Tenofovir / therapeutic use

Substances

Anti-HIV Agents
Pharmaceutical Preparations
Tenofovir
Emtricitabine

Abstract

Publication types

MeSH terms

Substances

Grants and funding