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Acute HIV Diagnosis After Initiation of Pre-exposure Prophylaxis in a Young Adult Patient: A Case Report.

Authors
  • Warus, Jonathan1
  • Hidalgo, Marco A2
  • Belzer, Marvin3
  • Olson-Kennedy, Johanna3
  • 1 Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: [email protected].
  • 2 Division of Internal Medicine-Pediatrics and Preventive Medicine, University of California Los Angeles, Los Angeles, California.
  • 3 Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
Type
Published Article
Journal
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
Publication Date
Jan 01, 2024
Volume
74
Issue
1
Pages
205–207
Identifiers
DOI: 10.1016/j.jadohealth.2023.07.013
PMID: 37690011
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Oral pre-exposure prophylaxis (PrEP) in the prevention of human immunodeficiency virus (HIV) infection is highly effective, yet the majority of sexually active adolescents and young adults (AYAs) at highest risk for HIV infection, particularly AYA males who have sex with males, have not been prescribed this medication. Provider hesitancy in prescribing PrEP to at-risk AYA patients is often associated with concerns about patient nonadherence and its effect on inducing HIV medication resistance. This case report has two aims. First, to outline the clinical course for an AYA patient prescribed PrEP for 3 months and then found to have HIV with an M184V resistance mutation and subsequently started on HIV treatment. And second, to illustrate how the benefits of PrEP initiation outweigh its risks by presenting clinical data on resistance patterns to PrEP medications. The patient eventually achieved viral suppression within 5 months of starting HIV treatment which has been sustained up to 2 years. This case illustrates that M184V resistance mutations, although rarely associated with PrEP, are unlikely to impact options for HIV treatment. Providers should recommend and prescribe oral PrEP to AYA patients at risk for HIV infection without concern for nonadherence leading to HIV medication resistance. Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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