For Long-Acting PrEP, Adherence Matters Even More

In a recipient of long-acting pre-exposure prophylaxis, persistently low levels of rilpivirine led to drug resistance and a breakthrough infection.

Consistent use of pre-exposure prophylaxis (PrEP) reduces the risk for acquiring HIV infection, and inadequate adherence is a major reason for PrEP failure. Long-acting parenteral therapy has been proposed as a strategy to improve PrEP's efficacy by making adherence easier. Researchers now report a case of acquired resistance following a single dose of long-acting rilpivirine (TMC278LA) used in the SSAT 040 trial (Clin Pharmacol Ther 2014; 96:314).

One female trial participant unexpectedly developed a breakthrough HIV infection following sexual intercourse 41 days after receiving a single 300-mg injection of long-acting rilpivirine. On day 84, HIV seroconversion with wild-type virus was confirmed. A blood specimen from day 115, at the time o…

Reviewing Author

Charles B. Hicks, MD

Disclosures

Consultant / Advisory boardGilead Sciences; ViiV; Merck

RoyaltiesUpToDate, Inc.

Grant / Research supportNIH; Department of Health and Human Services

Charles B. Hicks, MD

Disclosures

Consultant / Advisory boardGilead Sciences; ViiV; Merck

RoyaltiesUpToDate, Inc.

Grant / Research supportNIH; Department of Health and Human Services

For Long-Acting PrEP, Adherence Matters Even More

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Reviewing Author