HIV drug resistance surveillance in countries scaling up pre-exposure prophylaxis

Overview

WHO recommends that pre-exposure prophylaxis (PrEP) be offered as an additional prevention choice for HIV-negative individuals at substantial risk of HIV infection as part of combination prevention approaches.

HIV drug resistance has been rarely reported among PrEP users who tested HIV positive in randomized controlled trials or open-label studies. However, PrEP-selected HIV drug resistance could potentially negatively impact the effectiveness of treatment options among PrEP users who acquire HIV, since there is a potential for overlapping resistance profiles between antiretroviral drugs used for both PrEP and first-line antiretroviral therapy.

WHO therefore recommends that PrEP scale-up be accompanied by surveillance of HIV drug resistance that may compromise the effectiveness of first-line antiretroviral therapy among PrEP users who acquire HIV. This technical guidance describes the methods and implementation considerations to monitor the prevalence of HIV drug resistance among PrEP users diagnosed with HIV through a cross-sectional survey. The outcomes of the survey will be used to inform the selection of maximally effective first-line combination antiretroviral therapy for PrEP users who acquire HIV.