Characterization of Human Immunodeficiency Virus (HIV) Infections in Women Who Received Injectable Cabotegravir or Tenofovir Disoproxil Fumarate/Emtricitabine for HIV Prevention: HPTN 084

Susan H. Eshleman, Jessica M. Fogel, Estelle Piwowar-Manning, Gordon Chau, Vanessa Cummings, Yaw Agyei, Paul Richardson, Philip Sullivan, Casey D. Haines, Lane R. Bushman, Christos Petropoulos, Deborah Persaud, Ryan Kofron, Craig W. Hendrix, Peter L. Anderson, Jennifer Farrior, John Mellors, Adeola Adeyeye, Alex Rinehart, Marty St ClairSusan Ford, James F. Rooney, Carrie Anne Mathew, Portia Hunidzarira, Elizabeth Spooner, Juliet Mpendo, Gonasagrie Nair, Myron S. Cohen, James P. Hughes, Mina Hosseinipour, Brett Hanscom, Sinead Delany-Moretlwe, Mark A. Marzinke

Research output: Contribution to journalArticlepeer-review

Abstract

Background: HIV Prevention Trials Network 084 demonstrated that long-acting injectable cabotegravir (CAB) was superior to daily oral tenofovir (TFV) disoproxil fumarate (TDF)/emtricitabine (FTC) for preventing human immunodeficiency virus (HIV) infection in sub-Saharan African women. This report describes HIV infections that occurred in the trial before unblinding. Methods: Testing was performed using HIV diagnostic assays, viral load testing, a single-copy RNA assay, and HIV genotyping. Plasma CAB, plasma TFV, and intraerythrocytic TFV-diphosphate concentrations were determined by liquid chromatography-tandem mass spectrometry. Results: Forty HIV infections were identified (CAB arm, 1 baseline infection, 3 incident infections; TDF/FTC arm, 36 incident infections). The incident infections in the CAB arm included 2 with no recent drug exposure and no CAB injections and 1 with delayed injections; in 35 of 36 cases in the TDF/FTC arm, drug concentrations indicated low or no adherence. None of the cases had CAB resistance. Nine women in the TDF/FTC arm had nonnucleoside reverse-transcriptase inhibitor resistance; 1 had the nucleoside reverse-transcriptase inhibitor resistance mutation, M184V. Conclusions: Almost all incident HIV infections occurred in the setting of unquantifiable or low drug concentrations. CAB resistance was not detected. Transmitted nonnucleoside reverse-transcriptase inhibitor resistance was common; 1 woman may have acquired nucleoside reverse-transcriptase inhibitor resistance from study drug exposure.

Original languageEnglish (US)
Pages (from-to)1741-1749
Number of pages9
JournalJournal of Infectious Diseases
Volume225
Issue number10
DOIs
StatePublished - May 15 2022

Keywords

  • Africa
  • HIV
  • HPTN 084
  • TDF/FTC
  • cabotegravir
  • injectable
  • long-acting
  • preexposure prophylaxis
  • prevention
  • women

ASJC Scopus subject areas

  • General Medicine

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