HIV breakthrough infection after 6 years of daily TDF/FTC oral PrEP with objectively documented optimal adherence.

Authors

Nicholas Brian Bana, Davide Moschese, Leonardo Francesco Rezzonico, Enrico Caruso, Camilla Muccini, Giulia Jole Burastero, Anna De Bona, Nicoletta Frattini, Federico D'Amico, Massimo Cernuschi, Elena Simoncini, Massimo Puoti, Roberto Rossotti

Published in

Sexually transmitted infections. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

Oral Pre-Exposure Prophylaxis (PrEP) is highly effective for HIV prevention when adherence is optimal, with rare HIV breakthrough infections usually happening within 1-2 years since PrEP start. After 6 years of daily PrEP, routine HIV testing identified seroconversion in a 46-year-old Italian cisgender man. He reported high adherence, confirmed by pharmacy refill history and plasma tenofovir concentration. Genotypic resistance test identified a recombinant HIV-1 strain with M184V and K70E reverse transcriptase mutations. Immediate antiretroviral therapy with FTC/TAF/DRV/c+DTG was initiated, achieving rapid viral suppression. A hair sample was sent for therapeutic drug monitoring and results were consistent with correct daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) before the acquisition of HIV infection. This case represents a rare PrEP failure after the longest reported duration of daily TDF/FTC PrEP with confirmed optimal adherence. It highlights that breakthrough HIV infection can occur even after many years of successful PrEP use, underlying the importance of periodic HIV surveillance.

PMID:
42844002
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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