{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:15:10Z","timestamp":1788992110044,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Early randomized controlled trials (RCTs) have confirmed high efficacy of pre\u2010exposure prophylaxis (PrEP) for preventing HIV infection in men who have sex with men (MSM) with high HIV exposure risk. Nevertheless, some PrEP failure cases have been reported despite adequate drug adherence. This review aims to summarize the common features of PrEP failure cases and discuss the implications of upscaling PrEP programmes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search based on articles and clinical trials was conducted through Medline and OVID, with keywords for accessing publications reporting \u2018true\u2019 PrEP failure in the presence of documented adherence to daily regimen of co\u2010formulated tenofovir disoproxil fumarate\/emtricitabone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten cases of \u2018true\u2019 PrEP failure were identified, all of which were preceded by continued practice of condomless anal sex, despite documented adherence. Dried blood spot and\/or hair analyses provided supporting evidence of adherence in eight cases. There was strong association of PrEP failure with recurrent or multiple sexually transmitted diseases and infection with resistant HIV viruses. Seroconversion was usually atypical or delayed because of significantly suppressed viral load, making diagnosis a clinical challenge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although it is uncommon, \u2018true\u2019 PrEP failure can occur in a real\u2010world situation, contrary to the outcome of early RCTs. Failure to identify HIV infection while on PrEP can potentially lead to the emergence of drug\u2010resistant virus. To achieve effective HIV prevention, PrEP programmes should emphasize safer sexual practice in addition to drug adherence. Early identification of PrEP failure is crucial, which requires the development of highly sensitive assays and their clinical application.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12989","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T09:54:19Z","timestamp":1604397259000},"page":"75-82","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["A review of reported cases of HIV pre\u2010exposure prophylaxis failure with resultant breakthrough HIV infections"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-6700","authenticated-orcid":false,"given":"KW","family":"To","sequence":"first","affiliation":[{"name":"Stanley Ho Centre for Emerging Infectious Diseases The Chinese University of Hong Kong Hong Kong China"},{"name":"Department of Medicine and Therapeutics Prince of Wales Hospital Hong Kong 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