Brief Report: New HIV Diagnoses in PrEP-Experienced and PrEP-Naive Persons in the ICONA Cohort

Background:The best therapeutic management for people with HIV (PWH) who have a history of preexposure prophylaxis (PrEP) is still debated.Objectives:The aim of this study was to describe recent HIV infections in PrEP users compared with people never exposed to PrEP.Methods:Multicentre retrospective analysis evaluating all recent HIV infections from 2018 to 2021 within the Italian Cohort Naive Antiretrovirals. PWH, PrEP experienced or not, were compared using chi 2 test and Wilcoxon rank-sum test for categorical and continuous variables, respectively. A mixed linear model was used to estimate the change of the estimated mean HIV-RNA in the first year after ART initiation, according to PrEP exposure.Results:Fifty-one recent HIV diagnoses were identified, 9 in PrEP-experienced people, with an increasing temporal trend over the study period. Clinicians often initiated four-drug ART or NRTI-avoiding regimens in PrEP-experienced individuals, but this approach did not result in better viral decay or faster virologic suppression compared with traditional three-drug regimens. All achieved viral suppression during follow-up, within a median of 5.1 (IQR, 3.2-8.7) months in PWH never exposed to PrEP and 5.2 (IQR 3.2-9.4) months in PrEP-experienced PWH (P = 0.937). M184I/V was the most common mutation in PrEP-experienced individuals (37.5%).Conclusions:An increasing number of people newly diagnosed with HIV report previous use of PrEP. All PrEP-experienced PWH in ICONA cohort have achieved rapid virologic suppression, even in cases with the presence of transmitted viral mutations.