The Effect of Oral Pre-Exposure Prophylaxis on the Progression of HIV-1 Seroconversion

for the Partners PrEP Study Team

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVE:: To investigate whether oral pre-exposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection. DESIGN:: Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda. METHODS:: Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals. RESULTS:: There was a significant increase in delayed site detection of infection associated with PrEP (OR?=?3.49, p?=?0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (OR?=?0.93, p?=?0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 days versus 17 days, p?=?0.05). Adjusted for Fiebig stage, viral RNA was ∼2/3 log lower in those assigned to PrEP compared to placebo; no differences were found in Architect S/CO at any stage. CONCLUSIONS:: Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.

Original languageEnglish (US)
JournalAIDS
DOIs
StateAccepted/In press - Jul 6 2017

Fingerprint

HIV Seropositivity
HIV-1
Placebos
HIV Infections
Tenofovir
Pre-Exposure Prophylaxis
Uganda
Kenya
Viral RNA
Carbon Monoxide
Infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

The Effect of Oral Pre-Exposure Prophylaxis on the Progression of HIV-1 Seroconversion. / for the Partners PrEP Study Team.

In: AIDS, 06.07.2017.

Research output: Contribution to journalArticle

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title = "The Effect of Oral Pre-Exposure Prophylaxis on the Progression of HIV-1 Seroconversion",
abstract = "OBJECTIVE:: To investigate whether oral pre-exposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection. DESIGN:: Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda. METHODS:: Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals. RESULTS:: There was a significant increase in delayed site detection of infection associated with PrEP (OR?=?3.49, p?=?0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (OR?=?0.93, p?=?0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 days versus 17 days, p?=?0.05). Adjusted for Fiebig stage, viral RNA was ∼2/3 log lower in those assigned to PrEP compared to placebo; no differences were found in Architect S/CO at any stage. CONCLUSIONS:: Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.",
author = "{for the Partners PrEP Study Team} and Deborah Donnell and Eric Ramos and Connie Celum and Jared Baeten and Joan Dragavon and Jordan Tappero and Lingappa, {Jairam R.} and Allan Ronald and Kenneth Fife and Coombs, {Robert W.}",
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AU - for the Partners PrEP Study Team

AU - Donnell, Deborah

AU - Ramos, Eric

AU - Celum, Connie

AU - Baeten, Jared

AU - Dragavon, Joan

AU - Tappero, Jordan

AU - Lingappa, Jairam R.

AU - Ronald, Allan

AU - Fife, Kenneth

AU - Coombs, Robert W.

PY - 2017/7/6

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N2 - OBJECTIVE:: To investigate whether oral pre-exposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection. DESIGN:: Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda. METHODS:: Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals. RESULTS:: There was a significant increase in delayed site detection of infection associated with PrEP (OR?=?3.49, p?=?0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (OR?=?0.93, p?=?0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 days versus 17 days, p?=?0.05). Adjusted for Fiebig stage, viral RNA was ∼2/3 log lower in those assigned to PrEP compared to placebo; no differences were found in Architect S/CO at any stage. CONCLUSIONS:: Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.

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