{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:56:16Z","timestamp":1791395776824,"version":"4.3.3"},"reference-count":5,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2026,9,26]]},"abstract":"<jats:p>Oral Pre-Exposure Prophylaxis (PrEP) is highly effective for HIV prevention when adherence is optimal, with rare HIV breakthrough infections usually happening within 1\u20132 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.<\/jats:p>","DOI":"10.1136\/sextrans-2026-057198","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:20:31Z","timestamp":1791393631000},"page":"sextrans-2026-057198","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["HIV breakthrough infection after 6 years of daily TDF\/FTC oral PrEP with objectively documented optimal adherence"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6467-3697","authenticated-orcid":false,"given":"Nicholas Brian","family":"Bana","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Moschese","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy"},{"name":"Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Francesco","family":"Rezzonico","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Caruso","sequence":"additional","affiliation":[{"name":"Milano Check Point ETS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Muccini","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"},{"name":"Milano Check Point ETS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia Jole","family":"Burastero","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"De Bona","sequence":"additional","affiliation":[{"name":"Milano Check Point ETS, Milan, Italy"},{"name":"University of Milan, Department of Infectious Diseases, ASST Santi Paolo e Carlo, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Frattini","sequence":"additional","affiliation":[{"name":"Milano Check Point ETS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Cernuschi","sequence":"additional","affiliation":[{"name":"Milano Check Point ETS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Simoncini","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Puoti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"},{"name":"Universit\u00e0 degli Studi di Milano-Bicocca, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Rossotti","sequence":"additional","affiliation":[{"name":"Milano Check Point ETS, Milan, Italy"},{"name":"University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100710202356000_sextrans-2026-057198v1.1","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/QAI.0000000000003576","article-title":"Brief Report: New HIV Diagnoses in PrEP-Experienced and PrEP-Naive Persons in the ICONA Cohort","volume":"98","author":"Taramasso","year":"2025","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026100710202356000_sextrans-2026-057198v1.2","doi-asserted-by":"crossref","DOI":"10.3390\/v16060951","article-title":"Breakthrough Acute HIV Infections among Pre-Exposure Prophylaxis Users with High Adherence: A Narrative Review","volume":"16","author":"Moschese","year":"2024","journal-title":"Viruses"},{"key":"2026100710202356000_sextrans-2026-057198v1.3","doi-asserted-by":"publisher","DOI":"10.1086\/503914"},{"key":"2026100710202356000_sextrans-2026-057198v1.4","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2015.0182"},{"key":"2026100710202356000_sextrans-2026-057198v1.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0083736","article-title":"Strong relationship between oral dose and tenofovir hair levels in a randomized trial: hair as a potential adherence measure for pre-exposure prophylaxis (PrEP)","volume":"9","author":"Liu","year":"2014","journal-title":"PLoS One"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2026-057198","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:20:31Z","timestamp":1791393631000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2026-057198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":5,"alternative-id":["10.1136\/sextrans-2026-057198"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2026-057198","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}