Background. The best therapeutic management for people with HIV who have a history of pre-exposure prophylaxis (PrEP) is still debated. Objectives. The aim of this study was to describe recent HIV infections in PrEP users compared with people never exposed to PrEP. Methods. Multicentre retrospective analysis evaluating all recent HIV infections from 2018 to 2021 within the Italian Cohort Naive Antiretrovirals (ICONA). PWH, PrEP-experienced or not, were compared using chi-squared test and Wilcoxon rank-sum test for categorical and continuous variables, respectively. A mixed linear model was used to estimate the change of the estimated mean HIV-RNA in the first year after ART initiation, according to PrEP exposure. Results. Fifty-one recent HIV diagnoses were identified, nine in PrEP-experienced people, with an increasing temporal trend over the study period. Clinicians often initiated four-drug ART or NRTI-avoiding regimens in PrEP-experienced individuals, but this approach did not result in better viral decay or faster virologic suppression compared with traditional three-drug regimens. All achieved viral suppression during follow-up, within a median of 5.1 (IQR 3.2-8.7) months in PWH never exposed to PrEP and 5.2 (IQR 3.2-9.4) months in PrEP-experienced PWH (p=0.937). M184I/V was the most common mutation in PrEP-experienced individuals (37.5%). Conclusions. An increasing number of people newly diagnosed with HIV report previous use of PrEP. All PrEP-experienced PWH in ICONA cohort have achieved rapid virologic suppression, even in cases with the presence of transmitted viral mutations.
