Sexually transmitted infections in MSM with tenofovir/emtricitabine-resistant or cabotegravir-resistant HIV.

OBJECTIVE

Sexually transmitted infections (STIs) are associated with an increased risk of HIV transmission, raising concerns in case of virus resistant (R) to the drugs currently approved for preexposure prophylaxis. We explored the incidence of STIs in MSM with HIV (MSMWH) and resistance to tenofovir/emtricitabine (TXF/FTC) and/or cabotegravir (CAB).

DESIGN

Retrospective, cohort study on MSMWH on antiretroviral treatment (ART) with at least one genotyping resistance test (GRT) including integrase.

METHODS

The following STIs were included in the analysis: Neisseria gonorrhoeae , Chlamydia trachomatis , Mycoplasma/Ureaplasma spp. (only if symptomatic), early syphilis (primary, secondary, or early latent), and mpox infections. Poisson regression modeled incidence rates (IRs) and 95% confidence intervals (95% CIs).

RESULTS

Overall, 638 MSMWH evaluated: 67 (10.5%) TXF/FTC-R, 4 (0.6%) CAB-R, and 13 (2%) TXF/FTC+CAB-R. During a median follow-up of 9.6 (7.3-11.7) years [5908 person-years of follow-up (PY)], 307 of 638 (48.1%) individuals developed 744 STIs: IR = 12.6 (95% CI = 11.7-13.5)/100 PY. Among 307 MSMWH who developed STIs, 34 (11.1%) had at least one STI at HIV load at least 200 copies/ml [21 (6.8%) ≥1000 copies/ml]. Thirty-two (10.4%) of 307 individuals with at least one incident STI had TXF/FTC-R and/or CAB-R strains; five (15.6%) of these developed STIs at HIV load at least 200 copies/ml (specifically, ≥1000 copies/ml). STI incidence was significantly lower in presence of drug resistance [either TXF/FTC-R or CAB-R: IR = 8.2 (95% CI = 6.2-10.5)/100 PY and incidence rate ratio (IRR) = 0.6 (95% CI = 0.5-0.8); TXF/FTC+CAB-R: IR = 2.9 (95% CI = 0.8-7.3)/100 PY and IRR = 0.2 (95% CI = 0.1-0.5)].

CONCLUSION

In our cohort of MSMWH, STI incidence was nonnegligible, although reduced, in presence of resistance to TXF/FTC and/or CAB. Discussion of HIV resistance test results should include the risk of sexual transmission uncontrolled by preexposure prophylaxis.