I’ve explained the importance of resistance at major think-tanks and people just don’t get it.
The world needs to prepare for a resurgence of HIV drug resistance if pre-exposure prophylaxis is widely adopted, a veteran HIV researcher warned the Microbicides 2010 Conference last week.
Dr John Mellors of the University of Pittsburgh has studied the dynamics of viral suppression and how drug resistance arises since the beginning of HIV therapy.
He admitted that, so far, “there are highly divergent opinions on whether PrEP will spread resistance.” There is only one person in a PrEP trial with documented seroconversion while taking PrEP whose drug resistance was measured and this person turned out to have non-resistant ‘wild type’ virus.
However four PrEP trials are due to produce results by the end of this year – of drug users in Thailand, gay men in the USA, heterosexuals in Botswana and the multi-country iPrEX trial in gay men – and if one produces a significant result there will be pressure to roll out national programmes. Adopting these without careful monitoring could spread resistance to tenofovir and emtricitabine (FTC), currently the only drugs under study as PrEP.