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

Overview

WHO recommends pre-exposure prophylaxis (PrEP) as a prevention choice for individuals at substantial risk of acquiring HIV infection, as part of combination prevention approaches. HIV drug resistance has been occasionally reported among PrEP users diagnosed with HIV in randomized controlled trials or open label studies.

However, HIV drug resistance among PrEP users could potentially negatively impact the effectiveness of antiretroviral therapy (ART) options among PrEP users who acquire HIV. This is because there is a potential for overlapping resistance profiles between antiretroviral drugs used for both PrEP and treatment. While concerns about drug resistance should not dampen enthusiasm for scaling up PrEP, WHO recommends that PrEP scale-up be accompanied by the surveillance of HIV drug resistance.

This publication updates the WHO concept note entitled HIV drug resistance surveillance in countries scaling up pre-exposure prophylaxis, published in 2020. It includes guidance that can be applied to any PrEP regimen, including long-acting injectable cabotegravir and the dapivirine vaginal ring, and the ability to enrol participants from PrEP sites, as well as ART clinics.