The author has no acknowledgements or financial or other interests to disclose. “
“Recent

studies have shown that pre-exposure find more prophylaxis (PrEP) can substantially reduce the chance of acquiring HIV infection. However, PrEP efficacy has been found to be compromised in macaque studies if the challenge virus is antiretroviral therapy (ART)-resistant. Our objective was to evaluate the likelihood that a UK man who has sex with men (MSM) would be exposed to PrEP-resistant HIV in a homosexual encounter with an HIV-infectious partner. Data from the UK Collaborative HIV Cohort (UK CHIC) study were linked to the UK HIV Drug Resistance Database for HIV-1-positive MSM patients seen between 2005 and 2008. Patients were categorized as undiagnosed; diagnosed but ART-naïve; ART-experienced and on treatment; and ART-experienced and on a treatment interruption. Considering current PrEP regimens, resistance to (a) tenofovir (TDF) alone, (b) TDF and emtricitabine (FTC), and

(c) TDF or FTC was estimated. Patients without resistance tests had PrEP resistance imputed using bootstrapping and logistic regression models. The population-level prevalence of PrEP resistance in HIV-infectious individuals in 2008 was estimated to be 1.6, 0.9 and 4.1% for PrEP resistance definitions a, b and c, respectively. Prevalence in ART-experienced patients Vasopressin Receptor was highest, with negligible circulating resistance amongst Inhibitor Library ART-naïve individuals. The levels of resistance declined over the period of study. Our analysis indicates low levels of resistance to proposed PrEP drugs. The estimated PrEP resistance prevalence in UK HIV-infected MSM is towards the lower range of values used in simulation studies which have suggested that circulating PrEP drug resistance will have a negligible impact on PrEP efficacy at the population level. Several recent trials have provided evidence that pre-exposure prophylaxis (PrEP) could be effective at reducing HIV transmission. The CAPRISA-004 trial [1], in South

African women, showed that a tenofovir (TDF) microbicide reduced HIV acquisition by 39% [95% confidence interval (CI) 6–60%] compared with a placebo. Two further trials investigating the use of combination oral emtricitabine (FTC) and TDF (TDF-FTC) PrEP in heterosexual African couples (CDC-TDF2 and PARTNERS PrEP) reported efficacies of 63% (95% CI 21–84%) and 73% (95% CI 49–85%), respectively, although another trial (FEM-PREP) in African women was terminated early after finding no protective effect for TDF-FTC. The iPrEx study [2] in men who have sex with men (MSM) found a 44% (95% CI 15–63%) reduction in HIV incidence in the TDF-FTC group. One of the dangers of using antiretroviral therapy (ART) for prevention is HIV ART resistance.