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O'Donnell JS, Jaberolansar N, Chappell KJ. Human T-lymphotropic virus type 1 and antiretroviral therapy: practical considerations for pre-exposure and post-exposure prophylaxis, transmission prevention, and mitigation of severe disease. THE LANCET. MICROBE 2024; 5:e400-e408. [PMID: 38246188 DOI: 10.1016/s2666-5247(23)00359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/23/2024]
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus associated with substantial risk of secondary (often life-threatening) disease for the estimated 10 million to 20 million people infected globally. Despite a clear need, no HTLV-1-specific vaccine or antiretroviral therapy has been developed to date. Instead, existing public and primary health-care interventions inadequately focus on infection prevention and management of secondary diseases. In this Personal View, we discuss the evidence that exists to support the sensitivity of HTLV-1 to antiretroviral therapies approved by the US Food and Drug Administration for the treatment of HIV-1, how this sensitivity is affected by clinically relevant virological and immunological features, and additional practical considerations for the use of antiretroviral therapies in the context of HTLV-1.
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Affiliation(s)
- Jake S O'Donnell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia; The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia.
| | - Noushin Jaberolansar
- The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia
| | - Keith J Chappell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia; The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia; Australian Infectious Disease Research Centre, The University of Queensland, St Lucia, QLD, Australia
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2
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Liu S, Yuan D, Zhou Y, Fu G, Wang B. Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies. Ann Med 2023; 55:2288309. [PMID: 38065681 PMCID: PMC10836249 DOI: 10.1080/07853890.2023.2288309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%-65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%-81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%-55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.
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Affiliation(s)
- Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Ying Zhou
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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3
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Fox JM, Lee MJ, Fairhead CL, Ledwaba-Chapman LM, Nori AV, McQuillan O, Wang Y, Clarke A, Menon-Johansson A. Self-start HIV postexposure prophylaxis (PEPSE), to reduce time to first dose and increase efficacy. Sex Transm Infect 2023; 99:367-372. [PMID: 36564186 DOI: 10.1136/sextrans-2022-055622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effectiveness of HIV postexposure prophylaxis (PEPSE) correlates with speed of uptake following HIV exposure. Time to first dose has not improved in the UK for over 10 years. On-demand pre-exposure prophylaxis (PrEP) has shown that people can self-start medication for HIV prevention.We hypothesised that advanced provision of PEPSE (HOME PEPSE) for men who have sex with men (MSM) to self- initiate would reduce time to first dose following HIV exposure. METHODS Phase IV, randomised, prospective, 48-week, open-label study was carried out. MSM at medium risk of acquiring HIV were randomised (1:1) to immediate or deferred standard of care (SOC) HOME PEPSE. Every 12 weeks, participants self-completed mental health/risk behaviour surveys and had HIV/sexually transmitted infection (STI) testing.HOME PEPSE comprised a 5-day pack of emtricitabine/tenofovir disoproxil fumarate/maraviroc 600 mg once daily initiated following potential exposure to HIV. If taken, participants completed a risk survey; PEPSE continuation was physician directed. Primary outcome was time from potential exposure to HIV to first PEPSE dose. FINDINGS 139 participants randomised 1:1; 69 to immediate HOME PEPSE and 70 to deferred HOME PEPSE. Median age 30 years (IQR 26-39), 75% white, 55% UK born and 72% university educated. 31 in HOME PEPSE and 15 in SOC arm initiated PEPSE. Uptake of HOME PEPSE was appropriate in 27/31 cases (87%, 95% CI: 71% to 95%). Median time from exposure to first dose was 7.3 hours (3.0, 20.9) for HOME PEPSE and 28.5 hours (17.3, 34.0) for SOC (p<0.01). HOME PEPSE was well tolerated with no discontinuations.No significant differences in missed opportunities for PEPSE uptake, sexual behaviour or bacterial STI infections between treatment arms. INTERPRETATION HOME PEPSE reduced the time from exposure to first-dose PEPSE by 21+ hours, with no impact on safety. This significantly improves the efficacy of PEPSE and provides an option for people declining PrEP.
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Affiliation(s)
- Julie M Fox
- Department of GUM and HIV, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Infectious Diseases, King's College London, London, UK
| | - Ming Jie Lee
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - Achyuta V Nori
- Department of GUM and HIV, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Orla McQuillan
- The Northern Contraception Sexual Health Service & HIV Service, Manchester University NHS Foundation Trust, Manchester, UK
| | - Yanzhong Wang
- Department of Infectious Diseases, King's College London, London, UK
| | - Amanda Clarke
- Department of GUM and HIV, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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4
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Deere JD, Merriam D, Leggat KM, Chang WLW, Méndez-Lagares G, Kieu H, Dutra J, Fontaine J, Lu W, Chin N, Chen C, Tran BCT, Salinas J, Miller CN, Deeks SG, Lifson JD, Engelman K, Magnani D, Reimann K, Stevenson M, Hartigan-O'Connor DJ. SIV clearance from neonatal macaques following transient CCR5 depletion. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.01.533682. [PMID: 37205470 PMCID: PMC10187202 DOI: 10.1101/2023.05.01.533682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Treatment of people with HIV (PWH) with antiretroviral therapy (ART) results in sustained suppression of viremia, but HIV persists indefinitely as integrated provirus in CD4-expressing cells. Intact persistent provirus, the "rebound competent viral reservoir" (RCVR), is the primary obstacle to achieving a cure. Most variants of HIV enter CD4 + T cells by binding to the chemokine receptor, CCR5. The RCVR has been successfully depleted only in a handful of PWH following cytotoxic chemotherapy and bone marrow transplantation from donors with a mutation in CCR5 . Here we show that long-term SIV remission and apparent cure can be achieved for infant macaques via targeted depletion of potential reservoir cells that express CCR5. Neonatal rhesus macaques were infected with virulent SIVmac251, then treated with ART beginning one week after infection, followed by treatment with either a CCR5/CD3-bispecific or a CD4-specific antibody, both of which depleted target cells and increased the rate of plasma viremia decrease. Upon subsequent cessation of ART, three of seven animals treated with CCR5/CD3-bispecific antibody rebounded quickly and two rebounded 3 or 6 months later. Remarkably, the other two animals remained aviremic and efforts to detect replication-competent virus were unsuccessful. Our results show that bispecific antibody treatment can achieve meaningful SIV reservoir depletion and suggest that functional HIV cure might be achievable for recently infected individuals having a restricted reservoir.
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5
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Johnson MM, Jones CE, Clark DN. The Effect of Treatment-Associated Mutations on HIV Replication and Transmission Cycles. Viruses 2022; 15:107. [PMID: 36680147 PMCID: PMC9861436 DOI: 10.3390/v15010107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
HIV/AIDS mortality has been decreasing over the last decade. While promising, this decrease correlated directly with increased use of antiretroviral drugs. As a natural consequence of its high mutation rate, treatments provide selection pressure that promotes the natural selection of escape mutants. Individuals may acquire drug-naive strains, or those that have already mutated due to treatment. Even within a host, mutation affects HIV tropism, where initial infection begins with R5-tropic virus, but the clinical transition to AIDS correlates with mutations that lead to an X4-tropic switch. Furthermore, the high mutation rate of HIV has spelled failure for all attempts at an effective vaccine. Pre-exposure drugs are currently the most effective drug-based preventatives, but their effectiveness is also threatened by viral mutation. From attachment and entry to assembly and release, the steps in the replication cycle are also discussed to describe the drug mechanisms and mutations that arise due to those drugs. Revealing the patterns of HIV-1 mutations, their effects, and the coordinated attempt to understand and control them will lead to effective use of current preventative measures and treatment options, as well as the development of new ones.
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Affiliation(s)
- Madison M. Johnson
- Department of Microbiology, Weber State University, Ogden, UT 84408, USA
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6
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Wang Y, Liu S, Zhang Y, Tan W, Xie W, Gan Y, Zheng C, Li H, Yang Z, Jiang L, Chen L, Zhao J. Use of HIV Post-Exposure Prophylaxis Among Men Who Have Sex With Men in Shenzhen, China: A Serial Cross-Sectional Study. AIDS Behav 2022; 26:3231-3241. [PMID: 35380286 DOI: 10.1007/s10461-022-03673-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 02/05/2023]
Abstract
HIV postexposure prophylaxis (PEP) has been prescribed to non-occupational people in recent years, but the implementation of PEP in China is still unclear. This study sought to examine the PEP use rate and factors associated with PEP in Men who have sex with men (MSM). We recruited HIV-negative MSM through offline methods from 2018 to 2020 in Shenzhen, China. Overall, PEP use increased from 3.92% to 2018, 5.73% in 2019, and 10.29% in 2020. Among 2833 participants who reported their most recent questionnaire, factors associated with PEP use included residence in Shenzhen less than 1 year, sexual intercourse with women, preferred way of finding sexual partners in MSM venues, multiple sexual partners (≥ 2), condom use, lubricant use, viagra use, less use of rush popper, HIV-related services and interest in initiating Pre-exposure prophylaxis (PrEP). The implementation of the PEP plan should focus on the groups that may be at risk of HIV infection and their continued risky behaviours. For the inappropriate use of PEP, PEP publicity should guide MSM to choose regular hospitals and strengthen HIV testing before and after PEP.
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Affiliation(s)
- Yao Wang
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Shaochu Liu
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yan Zhang
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Tan
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Xie
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongxia Gan
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Chenli Zheng
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hao Li
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhengrong Yang
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lijuan Jiang
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lin Chen
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jin Zhao
- Department of HIV/AIDS Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
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7
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Di Ciaccio M, Delabre RM, Vilotitch A, Corbelli GM, Villes V, Ros Sánchez A, Zantkuijl P, Sweers H, Sanchez F, Meulbroek M, Cairns G, Bernier A, Ghosn J, Carvalho Rocha LM, Cosmaro ML, Duken SB, Dan M, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. PrEP in the Context of Other HIV Risk Reduction Strategies Among Men Who Have Sex with Men: Results from the Flash! PrEP in Europe Survey. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2451-2464. [PMID: 35725849 PMCID: PMC9208709 DOI: 10.1007/s10508-022-02322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Combination HIV prevention covers a range of biomedical, behavioral, and socio-structural interventions. Despite the growing availability of pre-exposure prophylaxis (PrEP), it is not always accessible in European Centre for Disease Prevention and Control reporting countries and may not meet the needs of all at-risk populations. Based on the Flash! PrEP in Europe data, multiple correspondence analysis and hierarchical clustering were used to identify patterns in HIV prevention strategies among 9980 men who have sex with men (MSM). PrEP interest was evaluated among four identified clusters: (A) "high condom use, sometimes Treatment as Prevention (TasP)"; (B) "mix of methods, infrequent condom use"; (C) "high condom use, tendency to choose partners based on serological status" and (D) "moderate use of condoms mixed with other prevention strategies". Clusters B and D had higher PrEP interest. These results suggest that MSM use a range of behavioral and biomedical risk reduction strategies that are often combined. On-demand PrEP may meet the needs of MSM who infrequently use condoms and other prevention methods.
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Affiliation(s)
- Marion Di Ciaccio
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France.
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, 69500, Bron, France.
| | | | - Antoine Vilotitch
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Virginie Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | | | - Flor Sanchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Adeline Bernier
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - Jade Ghosn
- Hôpitaux Universitaires Paris Nord, Service des Maladies Infectieuses, Site Bichat-Claude Bernard, Paris, France
| | | | | | - Sascha Béla Duken
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Monica Dan
- Department of Research, Monitoring and Evaluation, ARAS, Bucarest, Romania
| | | | - Richard Stranz
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- Community-based Laboratory, AIDES, Pantin, France
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Daniela Rojas Castro
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
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8
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Cresswell F, Asanati K, Bhagani S, Boffito M, Delpech V, Ellis J, Fox J, Furness L, Kingston M, Mansouri M, Samarawickrama A, Smithson K, Sparrowhawk A, Rafferty P, Roper T, Waters L, Rodger A, Gupta N. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Med 2022; 23:494-545. [PMID: 35166004 DOI: 10.1111/hiv.13208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.
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Affiliation(s)
- Fiona Cresswell
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kaveh Asanati
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Sanjay Bhagani
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Valerie Delpech
- Department of Epidemiology, Public Health England, London, UK
| | - Jayne Ellis
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University College London, Hospitals NHS Foundation Trust, London, UK
| | - Julie Fox
- HIV Medicine and Clinical Trials, Guy's and St Thomas' Hospital, London, UK.,Kings College London, London, UK
| | | | - Margaret Kingston
- British Association of Sexual Health and HIV Clinical Effectiveness Group, Macclesfield, UK.,Manchester Royal Infirmary, Manchester, UK.,Manchester University, Manchester, UK
| | - Massoud Mansouri
- Occupational Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Paul Rafferty
- Belfast Health and Social Care Trust, Belfast, UK.,HIV Pharmacy Association Representative, Newcastle upon Tyne, UK
| | | | | | - Alison Rodger
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Nadi Gupta
- British HIV Association Guideline Committee, London, UK.,Rotherham NHS Foundation Trust, Rotherham, UK
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9
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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10
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Wang L, Huai P, Jiao K, Liu Y, Hua Y, Liu X, Wei C, Ma W. Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study. Sex Health 2021; 18:239-247. [PMID: 34148566 DOI: 10.1071/sh20203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Background Male clients of female sex workers ('clients' hereafter) are considered high-risk and potentially a bridge population in the HIV epidemic. Non-occupational post-exposure prophylaxis (nPEP) is a safe and effective but under-utilised public health intervention to prevent HIV transmission. This study aims to explore clients' awareness of nPEP, intention of uptake, potential barriers to nPEP uptake and adherence, and suggestions for nPEP promotion in China. METHODS We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. RESULTS Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. CONCLUSIONS Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.
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Affiliation(s)
- Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yicong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yumeng Hua
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Xueyuan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Chongyi Wei
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA; and Corresponding authors. Emails: ;
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China; and Corresponding authors. Emails: ;
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11
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Yingling C, Broholm C, Stephenson S. Pharmacoprevention of Human Immunodeficiency Virus Infection. Nurs Clin North Am 2020; 55:429-444. [PMID: 32762861 DOI: 10.1016/j.cnur.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews the disparities in human immunodeficiency virus (HIV) incidence, presents evidence on the efficacy of preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP), provides an overview of clinical guidelines for prescribing PrEP and nPEP, discusses strategies to promote efficient use of these effective interventions, and reviews best practices in treatment retention for people at high risk for HIV. Nurses are optimally positioned to prevent new HIV infections. When working with sensitive topics such as sexual practices and substance use, nurses excel at building rapport, making shared decisions, and educating about risk reduction with an affirming, nonjudgmental approach.
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Affiliation(s)
- Charles Yingling
- Department of Population Health Nursing Science, University of Illinois at Chicago College of Nursing, 845 South Damen Avenue, Chicago, IL 60612, USA.
| | - Cindy Broholm
- Harriet Rothkopf Heilbrunn School of Nursing, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
| | - Shirley Stephenson
- Department of Population Health Nursing Science, University of Illinois at Chicago College of Nursing, 3240 West Division Street, Chicago, IL 60651, USA
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Chauveau M, Billaud E, Bonnet B, Merrien D, Hitoto H, Bouchez S, Michau C, Hall N, Perez L, Sécher S, Raffi F, Allavena C. Tenofovir DF/emtricitabine/rilpivirine as HIV post-exposure prophylaxis: results from a multicentre prospective study. J Antimicrob Chemother 2020; 74:1021-1027. [PMID: 30689937 DOI: 10.1093/jac/dky547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Since 2016, French guidelines have recommended the single-tablet regimen of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/rilpivirine (RPV) as HIV post-exposure prophylaxis (PEP), but few data support this usage. We evaluated the tolerability, treatment completion and occurrence of HIV seroconversion associated with this combination in occupational and non-occupational PEP. PATIENTS AND METHODS We conducted an observational, prospective, multicentre, open-label, non-randomized study in five French HIV centres. Adults requiring PEP according to national French guidelines were prescribed TDF/FTC/RPV one pill once a day for 28 days. Clinical and biological tolerability was assessed at week 4; occurrence of HIV seroconversion was evaluated after week 16. RESULTS From March 2016 to March 2017, 163 courses of PEP were prescribed for 150 sexual exposures (44% heterosexual and 56% MSM) and 13 non-sexual exposures. Five participants stopped PEP after a few days because the source person was HIV uninfected. Of the remaining 158 individuals, 15 (9.5%) were lost to follow-up at week 4, 7 (4.4%) prematurely discontinued PEP [patient's decision/non-adherence (n = 3) or adverse events (gastrointestinal intolerance n = 3, fatigue n = 1)] and 136 (86.1%) completed the 28 day treatment. Overall, 69.6% of participants declared at least one adverse event, mostly of mild to moderate intensity and no serious adverse events or hepatic or renal toxicity occurred. No HIV seroconversion occurred at week 16. CONCLUSIONS The low rate of premature treatment interruption, the good tolerability and the absence of documented HIV seroconversion support the current French guidelines of a 28 day course of TDF/FTC/RPV for sexual and non-sexual PEP.
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Affiliation(s)
- Marie Chauveau
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France
| | - Eric Billaud
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France.,COREVIH Pays de la Loire, CHU Hôtel-Dieu, Nantes, France
| | - Bénédicte Bonnet
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France
| | | | | | | | | | - Nolwenn Hall
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France
| | - Lucia Perez
- Internal Medicine Department, CH Le Mans, France
| | - Solène Sécher
- COREVIH Pays de la Loire, CHU Hôtel-Dieu, Nantes, France
| | - François Raffi
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France.,CIC UIC 1413 INSERM, CHU Nantes, France
| | - Clotilde Allavena
- Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France.,CIC UIC 1413 INSERM, CHU Nantes, France
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Gantner P, Allavena C, Duvivier C, Cabie A, Reynes J, Makinson A, Ravaux I, Bregigeon S, Cotte L, Rey D. Post-exposure prophylaxis completion and condom use in the context of potential sexual exposure to HIV. HIV Med 2020; 21:463-469. [PMID: 32558205 DOI: 10.1111/hiv.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Post-exposure prophylaxis (PEP) care remains a challenge for individuals with potential sexual exposure to HIV in terms of PEP completion and ongoing risk behaviours. METHODS A retrospective analysis was carried out on data from the French Dat'AIDS prevention cohort (NCT03795376) for individuals evaluated for PEP between 2004 and 2017. A multivariable analysis was performed of predictors of both PEP completion and condom use [odds ratios (ORs)] and their associated probabilities (P, with P > 95% being clinically relevant). RESULTS Overall, 29 060 sexual exposures to HIV were evaluated for PEP [36% in men who have sex with men (MSM) and 64% in heterosexuals]. Overall, 12 different PEP regimens were offered in 19 240 cases (46%). Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) was the preferred backbone (n = 14 304; 74%). We observed a shift from boosted protease inhibitor-based regimens to nonnucleoside reverse transcriptase inhibitor- or integrase inhibitor-based regimens in recent years. Overall, 20% of PEP prescriptions were prematurely discontinued. Older age, MSM, intercourse with a sex worker, rape and intercourse with a known HIV-infected source patient were factors associated with increased rates of PEP completion (OR > 1; P > 98%). None of the 12 PEP regimens was associated with premature discontinuation. We also found 12 774 cases of unprotected sexual intercourse (48%). Condom use decreased (OR < 1; P > 99%) with the year of exposure, and was lower in MSM and rape victims. Condom use increased (OR > 1, P > 99%) with age, and was higher in those who had intercourse with a sex worker or with a female partner and in those with knowledge of the partner's HIV status. CONCLUSIONS We provide new insights into how rates of condom use and PEP completion might be improved in those receiving PEP by targeting certain groups of individuals for interventions. In particular, youth and MSM at risk should be linked in a prevention-to-care continuum.
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Affiliation(s)
- P Gantner
- Molecular Virology Department, Strasbourg University Hospital, Strasbourg, France.,INSERM, UMR-S U1109, Strasbourg University, Strasbourg, France
| | - C Allavena
- Infectious Diseases Department, Hôtel-Dieu Hospital, Nantes, France
| | - C Duvivier
- Infectious Diseases Department, Necker-Pasteur Infectiology Center, AP-HP-Necker Hospital, Paris, France.,Necker-Pasteur Infectiology Center, Medical Center of Pasteur Institute, Paris, France.,Paris Descartes University, EA7327, Sorbonne Paris Cité, Paris, France.,IHU Imagine, Paris, France
| | - A Cabie
- Infectious Diseases Department, Inserm CIC1424, Antilles University EA 4537, CHU de Martinique, Martinique, France
| | - J Reynes
- Infectious Diseases Department, Inserm U1175, CHU Montpellier, Montpellier, France
| | - A Makinson
- Infectious Diseases Department, Inserm U1175, CHU Montpellier, Montpellier, France
| | - I Ravaux
- AP-HM, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - S Bregigeon
- AP-HM, Clinical Immuno-Hematology Department, CHU Sainte-Marguerite, Marseille, France
| | - L Cotte
- Infectious Diseases Department, Croix Rousse Hospital, Lyon, France
| | - D Rey
- Le Trait d'Union, HIV-Infection Care Center, Strasbourg University Hospital, Strasbourg, France
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HIV Seroconversion in the Era of Pharmacologic Prevention: A Case-Control Study at a San Francisco STD Clinic. J Acquir Immune Defic Syndr 2020; 82:159-165. [PMID: 31192823 DOI: 10.1097/qai.0000000000002107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The comparative effectiveness of pre- and post-exposure prophylaxis (PrEP and PEP) for men who have sex with men (MSM) is unclear. SETTING We conducted a case-control study of MSM who were initially HIV-uninfected during September 1, 2012-June 30, 2016 at San Francisco's only municipal sexually transmitted diseases (STDs) clinic. METHODS Each case was matched with up to 3 controls based on age, baseline visit date, and follow-up time. The primary dependent variable was HIV seroconversion; the primary independent variable was exposure to PrEP, PEP, or neither. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Of 638 MSM (161 cases and 477 controls), 137 reported ever taking PrEP, 98 reported taking PEP-only, and 403 took neither. PrEP takers had more non-HIV sexually transmitted diseases during the analysis (72.3% vs. 55.1% vs. 42.4% P < 0.01) and were more likely to report receptive anal sex in the past 3 months (86.5% vs. 80.4% vs. 73.0%; P < 0.01). In the adjusted model, PrEP was associated with lower odds of HIV seroconversion (odds ratio 0.24; 95% confidence interval: 0.13 to 0.46) while PEP use had no effect on HIV acquisition compared with taking neither. CONCLUSIONS MSM who ever used PrEP demonstrated equal or higher sexual risk compared with those using neither PrEP nor PEP but had 76% lower odds of HIV seroconversion. MSM who used PEP but never PrEP were no less likely to seroconvert than those using neither. MSM should be offered PrEP. PEP users with ongoing risk of HIV infection should be connected to PrEP after PEP.
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Ahaus P, Potthoff A, Kayser A, Wach J, Brockmeyer NH, Skaletz-Rorowski A. [HIV pre-exposure prophylaxis care in intersectoral collaboration : Interim analysis of a monocentric, prospective study in Germany]. Hautarzt 2020; 71:211-218. [PMID: 32125439 DOI: 10.1007/s00105-020-04545-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP), a further opportunity to prevent HIV, is available at the WIR-Walk In Ruhr, Centre for Sexual Health and Medicine, as part of an innovative model project for intersectoral PrEP care. RESEARCH OBJECTIVES The present study describes the collective of persons provided with PrEP and how PrEP use influences sexual risk behaviour, the incidence of sexually transmitted diseases (STD) and adverse drug reactions. METHODS A total of 139 men who started PrEP between 10/2017 and 12/2018 have been included in the study. During a period of 13 months of PrEP treatment, all PrEP users received questionnaires; side effects, HIV and other STI were also monitored via clinical laboratory examinations. RESULTS The participants' average age was 38 years and 98.6% of them were men who had sex with men (MSM). Most of them had a high educational background; the unemployment rate was low. The average number of sexual partners within the last 6 months increased significantly, while the use of condoms decreased. In all, 44 STI were found in 34 participants within the first 4 months. No one was infected with HIV. Within the first 4 weeks of PrEP, 38.8% of the participants suffered from side effects, mainly gastrointestinal symptoms. CONCLUSION Most of the participants were working in a job or a vocational training. The sexual risk behaviour increased in the course of using PrEP resulting in a high incidence of STD. Side effects appeared most frequently in the first few weeks after starting PrEP.
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Affiliation(s)
- Patrick Ahaus
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland.,WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland
| | - Anja Potthoff
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland.,WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland
| | - Arne Kayser
- WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland.,Aidshilfe Bochum e. V., Bochum, Deutschland
| | - Janet Wach
- WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland.,Gesundheitsamt Bochum, Bochum, Deutschland
| | - Norbert H Brockmeyer
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland. .,WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland.
| | - Adriane Skaletz-Rorowski
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland.,WIR - Walk In Ruhr - Zentrum für Sexuelle Gesundheit und Medizin, Bochum, Deutschland
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16
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Alghamdi A, Hempel A, Heendeniya A, Clifford-Rashotte M, Tan DHS, Bogoch II. HIV postexposure prophylaxis-in-pocket: long-term follow-up of individuals with low-frequency, high-risk HIV exposures. AIDS 2020; 34:433-437. [PMID: 31996594 DOI: 10.1097/qad.0000000000002441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV preexposure prophylaxis and postexposure prophylaxis are two major biomedical HIV prevention modalities. The utility of these prevention tools for individuals with infrequent high-risk HIV exposures remains uncertain. HIV postexposure prophylaxis-in-pocket ('PIP') may be an effective HIV prevention tool in such situations. Here, we present long-term follow-up of a cohort of patients initiated on PIP for HIV prevention. METHODS We retrospectively evaluated clinical characteristics of patients initiated on PIP as a primary HIV prevention tool between 1 January 2016 to 31 May 2019 at the Toronto General Hospital HIV Prevention Clinic and St. Michael's Hospital HIV Clinic, both in Toronto, Canada. Patients were referred for consideration of a biomedical HIV prevention modality. Individuals with a low frequency of high-risk exposures to HIV were initiated on PIP after counselling, and were followed at regular intervals. Demographic and clinical data was collected with a standardized form. RESULTS In total, 79 patients were initiated on PIP as a primary HIV prevention modality and followed for a mean duration of 14.8 months combining for a total of 97.3 patient-years. Twenty-one (26.6%) patients used their PIP, and 32 courses of PIP were taken during the study period. Transitions between HIV prevention modalities included 13 (16.5%) patients who transitioned from PrEP to PIP, and 22 (27.8%) patients who transitioned from PIP to PrEP. No HIV seroconversions were detected during the course of this study. CONCLUSION PIP is helpful HIV prevention modality for individuals with a low frequency of high-risk HIV exposures.
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Affiliation(s)
| | | | | | | | - Darrell H S Tan
- Department of Medicine, University of Toronto
- Division of Infectious Diseases
- MAP Centre for Urban Health Solutions, St. Michael's Hospital
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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17
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Yankellow I, Yingling CT. Nonoccupational Postexposure Prophylaxis: An Essential Tool for HIV Prevention. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Heendeniya A, Bogoch II. Antiretroviral Medications for the Prevention of HIV Infection: A Clinical Approach to Preexposure Prophylaxis, Postexposure Prophylaxis, and Treatment as Prevention. Infect Dis Clin North Am 2019; 33:629-646. [PMID: 31239092 DOI: 10.1016/j.idc.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preventing new human immunodeficiency virus (HIV) infections is essential to halting the global pandemic. HIV prevention strategies include integrating both nonpharmacologic (eg, safe sexual counseling, circumcision) and pharmacologic approaches. Several pharmacologic HIV prevention strategies are increasingly used globally and include postexposure prophylaxis, preexposure prophylaxis, and treatment as prevention. These prevention modalities have enormous clinical and public health appeal, as they effectively reduce HIV acquisition in individuals and also may lower HIV incidence in communities when integrated and implemented broadly. Efforts are now underway to scale HIV prevention programs using these techniques in both high- and low-resource settings.
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Affiliation(s)
- Amila Heendeniya
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Isaac I Bogoch
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario M5G 2C4, Canada; Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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19
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Brief Report: HIV Postexposure Prophylaxis-in-Pocket ("PIP") for Individuals With Low-Frequency, High-Risk HIV Exposures. J Acquir Immune Defic Syndr 2019; 78:20-22. [PMID: 29419570 DOI: 10.1097/qai.0000000000001639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND On-demand preexposure prophylaxis may reduce one's risk of HIV acquisition; however, it is unclear if individuals with a very low frequency of HIV exposures are conferred adequate protection. We evaluated a novel approach dubbed HIV postexposure prophylaxis-in-pocket ("PIP"), for individuals with a low frequency of high-risk HIV exposures. SETTING Two HIV clinics in Toronto, Canada, managing HIV prevention cases. METHODS A retrospective evaluation of patients referred to HIV clinics for preexposure prophylaxis between January 1, 2013, and September 30, 2017, inclusive. After counseling and education, selected patients were initiated on PIP if they were having very infrequent HIV exposures. RESULTS Thirty patients were prescribed PIP. Four patients (13.3%) used PIP during this study. There were no HIV seroconversions in 21.8 cumulative patient-years of PIP. CONCLUSIONS PIP may be a useful HIV prevention modality for individuals with a very low frequency of HIV exposures.
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20
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Hughes C, Yoong D, Giguère P, Hull M, Tan DHS. Canadian guideline on HIV preexposure prophylaxis and nonoccupational postexposure prophylaxis for pharmacists. Can Pharm J (Ott) 2019; 152:81-91. [PMID: 30886661 DOI: 10.1177/1715163519826171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christine Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alberta.,Department of Pharmacy (Yoong) and the Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto.,Department of Pharmacy (Giguère), The Ottawa Hospital, Ottawa, Ontario.,BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Hull)
| | - Deborah Yoong
- Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alberta.,Department of Pharmacy (Yoong) and the Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto.,Department of Pharmacy (Giguère), The Ottawa Hospital, Ottawa, Ontario.,BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Hull)
| | - Pierre Giguère
- Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alberta.,Department of Pharmacy (Yoong) and the Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto.,Department of Pharmacy (Giguère), The Ottawa Hospital, Ottawa, Ontario.,BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Hull)
| | - Mark Hull
- Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alberta.,Department of Pharmacy (Yoong) and the Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto.,Department of Pharmacy (Giguère), The Ottawa Hospital, Ottawa, Ontario.,BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Hull)
| | - Darrell H S Tan
- Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alberta.,Department of Pharmacy (Yoong) and the Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto.,Department of Pharmacy (Giguère), The Ottawa Hospital, Ottawa, Ontario.,BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Hull)
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Affiliation(s)
- Mark J Siedner
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ethan Tumarkin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario
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Libois A, Florence E, Derdelinckx I, Yombi JC, Henrard S, Uurlings F, Vandecasteele S, Allard SD, Demeester R, Van Wanzeele F, Ausselet N, De Wit S. Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017. Acta Clin Belg 2018; 73:275-280. [PMID: 29429390 DOI: 10.1080/17843286.2018.1428506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present the updated Belgian guidelines for the use of non-occupational HIV post-exposure prophylaxis (NONOPEP). This document is inspired by UK guidelines 2015, adapted to the Belgian situation and approved by all AIDS reference centers in Belgium. When recommended, NONOPEP should be initiated as soon as possible, preferably within 24 h of exposure but can be offered up to 72 h. The duration of NONOPEP should be 28 days. These current guidelines include epidemiologic estimations, which can be used to calculate the risk of infection after a potential exposure and help to decide whether or not to start prophylaxis. We review which medications to use in the context of the last Belgian NONOPEP convention, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving NONOPEP.
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Affiliation(s)
- Agnès Libois
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Inge Derdelinckx
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious Diseases and Tropical Medicine Unit, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Sophie Henrard
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
| | - Françoise Uurlings
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Stefaan Vandecasteele
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
| | - Sabine D. Allard
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Rémy Demeester
- Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium
| | - Filip Van Wanzeele
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, Ghent, Belgium
| | | | - Stéphane De Wit
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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O'Byrne P, Orser L, MacPherson P, Valela N. The patient rationale for seeking HIV PEP: Qualitative results from a nurse-led program. Public Health Nurs 2018; 35:386-395. [PMID: 29633326 DOI: 10.1111/phn.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND HIV PEP is an intervention to prevent HIV seroconversion among HIV-negative persons after they have come into contact with the virus. The literature suggests PEP is greater than 80% effective at reducing HIV seroconversion. To expand access to this prevention strategy, we established a nurse-led PEP program in two STI clinics. AIMS We sought to explore why people seek PEP, and their experiences using it. MATERIALS & METHODS We invited participants who used our PEP program to engage in semi-structured qualitative interviews. These were audio-recorded, transcribed verbatim, and analyzed using the techniques of thematic analysis. RESULTS Twelve men who initiated PEP through our program participated in an interview. Thematic analysis of the data identified three themes: (1) assessing risk, (2) euphoria and distress, and (3) reducing distress. DISCUSSION Based on our findings, it appears as though instances of condomless sex were atypical and unplanned, they occurred due to contextual factors (e.g., consent, desire to explore, sexual chemistry/intensity), and they resulted in a state of temporary euphoria, which, afterward, transformed into distress (i.e., "feel[ing] stupid"). The participants used PEP not only for HIV prevention, but also (and perhaps more so) to address their emotional state. PEP used seemed to primarily occur to address situations of atypical sexual contact with partners they did not "know" or "trust". CONCLUSION We feel these results help contextualize how potential PEP users view HIV risk assessments, and how they determine their need for this intervention.
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Affiliation(s)
| | - Lauren Orser
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Paul MacPherson
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nick Valela
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
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24
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Card KG, Lachowsky NJ, Cui Z, Carter A, Armstrong H, Shurgold S, Moore D, Hogg RS, Roth EA. A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:95-106. [PMID: 27987086 PMCID: PMC5474217 DOI: 10.1007/s10508-016-0879-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/16/2016] [Accepted: 10/08/2016] [Indexed: 05/30/2023]
Abstract
Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.
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Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Susan Shurgold
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
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Malinverni S, Gennotte AF, Schuster M, De Wit S, Mols P, Libois A. Adherence to HIV post-exposure prophylaxis: A multivariate regression analysis of a 5 years prospective cohort. J Infect 2017; 76:78-85. [PMID: 29074102 DOI: 10.1016/j.jinf.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-occupational post-exposure prophylaxis (nPEP) is a recommended public health intervention after a sexual or percutaneous exposure to human immunodeficiency virus (HIV). METHODS We conducted a prospective observational study recording consultations for nPEP at a reference HIV center in Brussels, Belgium from January 2011 to December 2015. We recorded attendance to follow-up, reported completion of nPEP and pharmacy records to measure adherence. Multivariate logistic regressions were performed to identify independent risk factors for adherence to nPEP and attendance to first follow-up visit at the STI clinic. FINDINGS Among 1881 patients receiving nPEP, 66.4% had a documented completion of a 28-day course of nPEP and 87.3% attended their first follow-up clinic visit. MSM (OR, 1.40; 95%CI, 1.04-1.90), being a native Belgian (OR, 1.50; 95%CI, 1.18-1.90), older age (OR, 1.02; 95%CI, 1.01-1.04), being a sexual assault survivor (OR, 0.59; 95%CI, 0.38-0.91), having had a previous nPEP treatment (OR, 1.44; 95%CI, 1.02-2.02), consultation during daytime (OR, 1.35; 95%CI, 1.07-1.70) and benefitting from a health insurance (OR, 2.11; 95%CI, 1.58-2.89) were significant independent predictors for adherence to nPEP. Patients whose initial treatment was AZT/3TC/IDV/r had similar adherence than patients on d4T/3TC/LPV/r (OR, 0.898; 95%CI, 0.68-1.20). INTERPRETATION Multiple independent risk factors for nPEP retention into care and adherence are present at treatment initiation and might be targeted by tailored interventions. Sexual assault victims are overexposed to deleterious consequences of the lack of health insurance on compliance.
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Affiliation(s)
- Stefano Malinverni
- Emergency Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium.
| | - Anne-Françoise Gennotte
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Monica Schuster
- Institute of Development Policy and Management (IOB), University of Antwerp, Antwerp, Belgium
| | - Stéphane De Wit
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Mols
- Department of Emergency Medicine, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Beymer MR, Weiss RE, Bolan RK, Kofron RM, Flynn RP, Pieribone DL, Kulkarni SP, Landovitz RJ. Differentiating Nonoccupational Postexposure Prophylaxis Seroconverters and Non-Seroconverters in a Community-Based Clinic in Los Angeles, California. Open Forum Infect Dis 2017; 4:ofx061. [PMID: 28596981 DOI: 10.1093/ofid/ofx061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/29/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nonoccupational postexposure prophylaxis (nPEP) is a 28-day regimen of antiretroviral medications taken within 72 hours of human immunodeficiency virus (HIV) exposure to prevent HIV acquisition. Although nPEP has been recommended since 1998, few studies have analyzed the characteristics that distinguish nPEP failures (seroconverters) and successes (non-seroconverters). METHODS This retrospective study analyzed all nPEP courses prompted by sexual exposure that were prescribed at the Los Angeles LGBT Center between March 2010 and July 2014. Fisher exact tests and logistic regressions were used to determine characteristics that distinguished nPEP seroconverters from non-seroconverters. RESULTS Of the nPEP courses administered, 1744 had a follow-up visit for HIV testing within 24 weeks of exposure and 17 individuals seroconverted. Seven reported a known re-exposure, 8 self-reported only condom-protected sex subsequent to the initial exposure, and 2 reported abstinence since the exposure. In multivariable analyses, seroconverters were more likely than non-seroconverters to report methamphetamine use, incomplete medication adherence, and nPEP initiation later in the 72-hour window. CONCLUSIONS Nonoccupational postexposure prophylaxis is an important emergency tool for HIV prevention. Our findings corroborate that timing of the initial nPEP dose is an important predictor of seroconversion. Although the current study did not offer the initial nPEP dose at the beginning of the visit, use of this fast-track dosing schedule will ensure that the first dose is taken as early as possible postexposure and may lower the likelihood for seroconversion. Furthermore, we recommend systematic screening for substance use because these individuals may be well suited for pre-exposure prophylaxis given their sustained risk.
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Affiliation(s)
- Matthew R Beymer
- Los Angeles LGBT Center, California.,Division of Infectious Diseases, Department of Medicine and
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | | | - Ryan M Kofron
- Center for Clinical AIDS Research and Education, Los Angeles, California
| | | | | | | | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, Los Angeles, California.,County of Los Angeles Department of Public Health, Division of HIV and STD Programs, California; and
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DiStefano AS, Takeda M. HIV Pre-Exposure Prophylaxis and Postexposure Prophylaxis in Japan: Context of Use and Directions for Future Research and Action. AIDS Patient Care STDS 2017; 31:60-77. [PMID: 28170304 DOI: 10.1089/apc.2016.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Biomedical HIV prevention strategies are playing an increasingly prominent role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. We conducted an ethnographic study to determine the context of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) use and to identify directions for future research and action in Japan. We used data from observational fieldwork in the Kansai region and Tokyo Metropolitan Area (n = 178 persons observed), qualitative interviews (n = 32), documents and web-based data sources (n = 321), and email correspondences (n = 9) in the period 2013-2016. Drug approvals by Japan's regulatory agencies, insurance coverage for medications, and policies by healthcare institutions and government agencies were the main factors affecting PrEP and PEP legality, use, and awareness. Awareness and the observable presence of PrEP and PEP were very limited, particularly at the community level. PrEP and PEP held appeal for Japanese scientists and activists, and for study participants who represented various other stakeholder groups; however, significant concerns prevented open endorsements. Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider formal approval of antiretroviral (ARV) medications for use in PrEP and both occupational and nonoccupational PEP. Once approved, social marketing campaigns can be used to advertise widely and increase awareness. Future research would benefit from theoretical grounding in a diffusion of innovations framework. These findings can inform current and future ARV-based prevention strategies at a critical time in the international conversation.
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Affiliation(s)
- Anthony S. DiStefano
- Department of Health Science, California State University, Fullerton, Fullerton, California
| | - Makiko Takeda
- Program in Comparative Cultures, Graduate School of Humanities, Josai International University, Togane, Japan
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Otis J, McFadyen A, Haig T, Blais M, Cox J, Brenner B, Rousseau R, Émond G, Roger M, Wainberg M. Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada. AIDS Behav 2016; 20:2812-2826. [PMID: 26961381 PMCID: PMC5108827 DOI: 10.1007/s10461-016-1344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.
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Affiliation(s)
- Joanne Otis
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, Canada.
| | - Amélie McFadyen
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Thomas Haig
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- COCQ-SIDA, Montreal, QC, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Joseph Cox
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Bluma Brenner
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Gilbert Émond
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Michel Roger
- Laboratoire de Biologie Moléculaire, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada
| | - Mark Wainberg
- Faculty of Medicine, McGill University, Montreal, QC, Canada
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Leal L, Torres B, León A, Lucero C, Inciarte A, Diaz-Brito V, de Lazzari E, Gatell JM, García F. Predictive Factors for HIV Seroconversion Among Individuals Attending a Specialized Center After an HIV Risk Exposure: A Case-Control Study. AIDS Res Hum Retroviruses 2016; 32:1016-1021. [PMID: 27457508 DOI: 10.1089/aid.2016.0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To better target our current prevention strategies, we assessed factors associated with HIV seroconversion in individuals attending a specialized center after a risk exposure. MATERIALS AND METHODS We studied individuals from an HIV Unit's contact risk cohort at a tertiary care hospital in Barcelona, Spain, between 2003 and 2013 and performed a retrospective matched case-control study. Cases were individuals who seroconverted to HIV after at least 3 months since first follow-up visit for a contracting risk. Controls were HIV-negative individuals from the same cohort. Demographics and behavior variables were studied and compared using a McNemar test assessing factors associated with seroconversion. Univariate analysis and binary logistic regression were performed to develop a model for predicting probability of HIV seroconversion. We also evaluated sensitivity and specificity of our model and an area under Receiver Operating Characteristic (ROC) curve was estimated. RESULTS Sixty-nine (2.2%) individuals seroconverted after a median (interquartile range) of 24 (9-34) months since last follow-up. Seroconverters were predominantly male (96%) and men who have sex with men (MSM) (94%). No differences were observed regarding risk of exposure. Being MSM [odds ratio (OR) 5.2 (1.4-20.2), p = .01], having a known HIV-positive partner [OR 2.7 (1.2-6.2), p = .02], previous postexposure prophylaxis (PEP) [OR 3.9 (1.0-15.6), p = .05], and having previous sexually transmitted infections (STIs) [OR 4.6 (1.9-10.9), p = .001] were the factors independently associated with HIV seroconversion. The sensitivity and specificity of our model were 64.06% and 73.53%, respectively, and the area under ROC curve was 0.777. DISCUSSION HIV seroconversions were observed frequently between individuals attending a specialized center because of a risk exposure. Being MSM, having had previous PEP, an HIV-positive sexual partner, and previous STI were predictive factors for HIV seroconversion. Closer and longer follow-up and/or pre-exposure prophylaxis should be considered to prevent HIV infections in this high-risk population.
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Affiliation(s)
- Lorna Leal
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Berta Torres
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Agathe León
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Constanza Lucero
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Vicens Diaz-Brito
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Elisa de Lazzari
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José María Gatell
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Felipe García
- HIV Vaccine Development in Catalonia (HIVACAT), Barcelona, Spain
- HIV Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Jaspal R, Nerlich B. A ‘morning-after’ pill for HIV? Social representations of post-exposure prophylaxis for HIV in the British print media. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1222354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Cresswell F, Waters L, Briggs E, Fox J, Harbottle J, Hawkins D, Murchie M, Radcliffe K, Rafferty P, Rodger A, Fisher M. UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015. Int J STD AIDS 2016; 27:713-38. [PMID: 27095790 DOI: 10.1177/0956462416641813] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
Abstract
We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.
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32
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Leal L, León A, Torres B, Inciarte A, Lucero C, Mallolas J, Laguno M, Martínez-Rebollar M, González-Cordón A, Manzardo C, Rojas J, Pich J, Arnaiz JA, Gatell JM, García F. A randomized clinical trial comparing ritonavir-boosted lopinavir versus raltegravir each with tenofovir plus emtricitabine for post-exposure prophylaxis for HIV infection. J Antimicrob Chemother 2016; 71:1987-93. [PMID: 26994089 DOI: 10.1093/jac/dkw049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess post-exposure prophylaxis (PEP) non-completion at day 28, comparing two regimens. METHODS A prospective, open, randomized clinical trial was conducted at a tertiary hospital in Barcelona, Spain. Individuals attending the emergency room because of potential sexual exposure to HIV were randomized to tenofovir disoproxil/emtricitabine (245/200 mg) plus either ritonavir-boosted lopinavir (400/100 mg) or raltegravir (400 mg). The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse events and rate of seroconversions. This study was registered in ClinicalTrials.gov: NCT01576731. RESULTS One-hundred-and-twenty-one individuals were randomized to receive ritonavir-boosted lopinavir and 122 to raltegravir (n = 243). PEP non-completion at day 28 was 43% with no significant difference between arms. We performed a modified ITT analysis including only those patients who attended on day 1 (n = 191). PEP non-completion in this subgroup was higher in the ritonavir-boosted lopinavir arm than in the raltegravir arm (34.6% versus 20.4%, P = 0.04), as was the number of patients lost to follow-up at day 28 (32.6% versus 21.6%, P = 0.08) and the proportion of patients with low adherence (49.2% versus 30.8%, P = 0.03). Adverse events were significantly more common in the ritonavir-boosted lopinavir arm (73.4% versus 60.2%, P = 0.007). There was an HIV seroconversion at day 90 in the raltegravir arm in a patient who had multiple potential sexual risk exposures before and after receiving PEP. CONCLUSIONS Although we found no differences between arms regarding PEP non-completion, poor adherence and adverse events were significantly higher in patients allocated to tenofovir disoproxil/emtricitabine plus ritonavir-boosted lopinavir. These data support the use of raltegravir as the preferred third drug in current PEP recommendations.
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Affiliation(s)
- Lorna Leal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Agathe León
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Constanza Lucero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jhon Rojas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Judit Pich
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan A Arnaiz
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep M Gatell
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Felipe García
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Antiretrovirals for primary HIV prevention: the current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep 2016; 12:127-38. [PMID: 25600106 DOI: 10.1007/s11904-014-0253-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-exposure prophylaxis (PEP) immediately after acute high-risk exposures and pre-exposure prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in "real-world" settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform the successful implementation of these promising prevention approaches.
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Agent-based computational model of the prevalence of gonococcal infections after the implementation of HIV pre-exposure prophylaxis guidelines. Online J Public Health Inform 2015; 7:e224. [PMID: 26834937 PMCID: PMC4731223 DOI: 10.5210/ojphi.v7i3.6104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Recently, the first comprehensive guidelines were published for pre-exposure prophylaxis (PrEP) for the prevention of HIV infection in populations with substantial risk of infection. Guidelines include a daily regimen of emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as well as condom usage during sexual activity. The relationship between the TDF/FTC intake regimen and condom usage is not yet fully understood. If men who have sex with men (MSM,) engage in high-risk sexual activities without using condoms when prescribed TDF/FTC they might be at an increased risk for other sexually transmitted diseases (STD). Our study focuses on the possible occurrence of behavioral changes among MSM in the United States over time with regard to condom usage. In particular, we were interested in creating a model of how increased uptake of TDF/FTC might cause a decline in condom usage, causing significant increases in non-HIV STD incidence, using gonococcal infection incidence as a biological endpoint. We used the agent-based modeling software NetLogo, building upon an existing model of HIV infection. We found no significant evidence for increased gonorrhea prevalence due to increased PrEP usage at any level of sample-wide usage, with a range of 0-90% PrEP usage. However, we did find significant evidence for decreased prevalence of HIV, with a maximal effect being reached when 5% to 10% of the MSM population used PrEP. Our findings appear to indicate that attitudes of aversion, within the medical community, toward the promotion of PrEP due to the potential risk of increased STD transmission are unfounded.
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Mitchell JW, Sophus AI, Petroll AE. HIV-Negative Partnered Men's Willingness to Use Non-Occupational Post-Exposure Prophylaxis and Associated Factors in a U.S. Sample of HIV-Negative and HIV-Discordant Male Couples. LGBT Health 2015; 3:146-52. [PMID: 26789400 DOI: 10.1089/lgbt.2015.0065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Non-occupational post-exposure prophylaxis (nPEP) is an underutilized biomedical option for HIV prevention. Few studies have assessed male couples' knowledge of and willingness to use nPEP. METHODS Cross-sectional dyadic data from 275 HIV-negative and 58 HIV-discordant male couples were used to describe HIV-negative, partnered men's awareness and willingness to use nPEP, and factors associated with their willingness to use nPEP. Data were analyzed with the use of multivariate multilevel modeling. RESULTS Less than a third of the men were aware of nPEP, yet 73% were very-to-extremely likely to use nPEP. Partnered men's willingness to use nPEP was positively associated with having an individual income less than $30,000 USD and serosorting within the relationship. Willingness to use nPEP was negatively associated with greater age difference between primary partners and with higher scores on measures of couples' investment in their relationship. CONCLUSION Efforts should be made to increase male couples' awareness of nPEP and how to access nPEP. Uptake of nPEP has the potential to help avert new HIV infections among male couples.
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Affiliation(s)
- Jason W Mitchell
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Amber I Sophus
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Andrew E Petroll
- 2 Division of Infectious Diseases, Center for AIDS Intervention Research , Medical College of Wisconsin, Milwaukee, Wisconsin
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Thomas R, Galanakis C, Vézina S, Longpré D, Boissonnault M, Huchet E, Charest L, Murphy D, Trottier B, Machouf N. Adherence to Post-Exposure Prophylaxis (PEP) and Incidence of HIV Seroconversion in a Major North American Cohort. PLoS One 2015; 10:e0142534. [PMID: 26559816 PMCID: PMC4641668 DOI: 10.1371/journal.pone.0142534] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/22/2015] [Indexed: 11/26/2022] Open
Abstract
Background There is limited evidence on the efficacy of post-exposure prophylaxis (PEP) for sexual exposures. We sought to determine the factors associated with adherence to treatment and describe the incidence of PEP failures in a Montreal clinic. Methods We prospectively assessed all patients consulting for PEP following sexual exposures from October 2000 to July 2014. Patients were followed at 4 and 16 weeks after starting PEP. Treatment adherence was determined by self-report at week 4. Multivariable logistic regression was used to estimate the factors predicting adherence to treatment. Results 3547 PEP consults were included. Patients were mainly male (92%), MSM (83%) and sought PEP for anal intercourse (72%). Seventy-eight percent (n = 2772) of patients received a prescription for PEP, consisting of Tenofovir/Emtracitabine (TVD) + Lopinavir/Ritonavir (LPV) in 74% of cases, followed by Zidovudine/Lamivudine (CBV) + LPV (10%) and TVD + Raltegravir (RAL) (8%). Seventy percent of patients were adherent to treatment. Compared to TVD+LPV, patients taking CBV+LPV were less likely to adhere to treatment (OR 0.58, 95% CI 0.44–0.75), while no difference was observed for patients taking TVD+RAL (OR 1.15, 95% CI 0.83–1.59). First-time PEP consults, older and male patients were also more adherent to treatment. Ten treated patients seroconverted (0.37%) during the study period, yet only 1 case can be attributed to PEP failure (failure rate = 0.04%). Conclusion PEP regimen was associated with treatment adherence. Patients were more likely to be adherent to TVD-based regimens. Ten patients seroconverted after taking PEP; however, only 1 case was a PEP failure as the remaining patients continued to engage in high-risk behavior during follow-up. One month PEP is an effective preventive measure to avoid HIV infection.
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Affiliation(s)
- Réjean Thomas
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | - Sylvie Vézina
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | | | | | | | - Daniel Murphy
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | - Nimâ Machouf
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
- * E-mail:
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Gaines H, Albert J, Axelsson M, Berglund T, Gisslén M, Sönnerborg A, Blaxhult A, Bogdanovic G, Brytting M, Carlander C, Flamholc L, Follin P, Haggar A, Hagstam P, Johansson M, Navér L, Persson Blom J, Samuelson A, Ström H, Sundqvist M, Svedhem Johansson V, Tegmark Wisell K, Tegnell A, Thorstensson R. Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy. Infect Dis (Lond) 2015; 48:93-8. [PMID: 26414596 DOI: 10.3109/23744235.2015.1089593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.
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Affiliation(s)
- Hans Gaines
- a Public Health Agency of Sweden , Solna .,b Unit of Infectious Diseases, Department of Medicine , Karolinska Institutet , Stockholm .,c Department of Infectious Diseases , Karolinska University Hospital , Stockholm
| | - Jan Albert
- d Department of Microbiology , Tumor and Cell Biology, Karolinska Institutet , Stockholm .,e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .,f Swedish Reference Group for Antiviral Therapy , Stockholm
| | | | | | - Magnus Gisslén
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,g Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Gothenburg
| | - Anders Sönnerborg
- c Department of Infectious Diseases , Karolinska University Hospital , Stockholm .,e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .,f Swedish Reference Group for Antiviral Therapy , Stockholm .,h Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet , Stockholm
| | - Anders Blaxhult
- i Department of Infectious Diseases , Södersjukhuset Venhälsan , Stockholm
| | - Gordana Bogdanovic
- e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm
| | | | - Christina Carlander
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,j Clinic of Infectious Diseases, County Hospital of Västmanland , Västerås
| | - Leo Flamholc
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,k Department of Infectious Diseases , University of Lund, Skåne University Hospital , Malmö
| | - Per Follin
- l Department of Communicable Disease Control and Prevention , Region Västra Götaland , Gothenburg
| | - Axana Haggar
- m National Board of Health and Welfare , Stockholm
| | - Per Hagstam
- n Department of Communicable Disease Control and Prevention , Skåne , Malmö
| | - Marcus Johansson
- o Department of Clinical Microbiology and Infectious Diseases , Kalmar County Hospital , Kalmar
| | - Lars Navér
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,p Department of Pediatrics , Karolinska University Hospital , Stockholm .,q Department of Clinical Science , Intervention and Technology, Karolinska Institute , Stockholm
| | | | - Agneta Samuelson
- e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm
| | - Helena Ström
- m National Board of Health and Welfare , Stockholm
| | - Martin Sundqvist
- s Department of Laboratory Medicine , Clinical Microbiology, Örebro University Hospital , Örebro , Sweden
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Changes to Initial Postexposure Prophylaxis Regimens Between the Emergency Department and Clinic. J Acquir Immune Defic Syndr 2015; 69:e182-4. [DOI: 10.1097/qai.0000000000000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Landovitz RJ, Fletcher JB, Shoptaw S, Reback CJ. Contingency management facilitates the use of postexposure prophylaxis among stimulant-using men who have sex with men. Open Forum Infect Dis 2015; 2:ofu114. [PMID: 25884003 PMCID: PMC4396429 DOI: 10.1093/ofid/ofu114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/04/2022] Open
Abstract
Compared to a control behavioral intervention, Contingency Management, an escalating voucher-based incentive system to reinforce stimulant abstinence, better supported MSM stimulant users in PEP course completion, decreased stimulant use, and a trend toward fewer condomless sexual acts. Background. Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence. Methods. We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent “yoked” control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors. Results. At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1–47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9–21.9). Conclusions. CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters.
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Affiliation(s)
- Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine , University of California
| | | | | | - Cathy J Reback
- Friends Research Institute, Inc., ; UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles
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Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. Subsequent HIV infection among men who have sex with men who used non-occupational post-exposure prophylaxis at a Boston community health center: 1997-2013. AIDS Patient Care STDS 2015; 29:20-5. [PMID: 25369451 DOI: 10.1089/apc.2014.0154] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Non-occupational post-exposure prophylaxis (NPEP) has been recommended to prevent HIV acquisition for nearly 20 years. However, limited behavioral and clinical outcome data exist after men who have sex with men (MSM) present for NPEP. We reviewed the electronic medical records of HIV-uninfected adults who presented for NPEP at a large community health center in Boston between July, 1997 and August, 2013. Data from 894 patients were analyzed, 88.1% of whom were MSM. Consensual unprotected sex was the most common reason for NPEP visits among MSM (64.2%), followed by condom failure (30.6%). The HIV serostatus of the partner was unknown for 64.4% of the MSM, positive with unknown treatment status for 18.1%, positive and not on treatment for 4.1%, and positive and on treatment for 13.4%. Thirty-nine patients subsequently became HIV-infected (4.4%), all of whom were MSM. The MSM-specific HIV incidence after NPEP use was 2.2 cases per 100 person-years. Incident HIV infection was associated with younger age (AHR=0.94; p=0.003), being Latino (AHR=2.44; p=0.044), and/or being African American (AHR=3.43; p=0.046). Repeated NPEP use was not associated with incident HIV infection (AHR=0.67; p=0.26). Younger MSM of color who access NPEP, in particular, may benefit from early HIV risk-reduction and pre-exposure prophylaxis counseling.
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Affiliation(s)
- Sachin Jain
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Catherine E. Oldenburg
- The Fenway Institute, Boston, Massachusetts
- Harvard School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Matthew J. Mimiaga
- The Fenway Institute, Boston, Massachusetts
- Harvard School of Public Health, Department of Epidemiology, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts
| | - Kenneth H. Mayer
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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41
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Abstract
The incidence of human immunodeficiency virus (HIV) infection continues to rise among core groups and efforts to reduce the numbers of new infections are being redoubled. Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36-72 hours of exposure to HIV. As long as individuals continue to be exposed to HIV there will be a role for PEP in the foreseeable future. Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE), has a significant role to play in HIV prevention efforts. Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. In this review, we provide current evidence for the use of PEPSE, assessment of the risk of HIV transmission, indications for PEP, drug regimens, and management of patients started on PEP. We summarize national and international guidelines for the use of PEPSE. We explore the place of PEP within the wider strategy of reducing HIV incidence rates in the era of treatment as prevention and pre-exposure prophylaxis. We also consider the implications of recent data from interventional and observational studies demonstrating significant reductions in the risk of HIV transmission within a serodiscordant relationship if the HIV-positive partner is taking effective ART upon PEP guidelines.
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Affiliation(s)
- Binta Sultan
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Paul Benn
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Laura Waters
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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42
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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection: an editorial review. AIDS 2014; 28:1545-54. [PMID: 24785956 DOI: 10.1097/qad.0000000000000301] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIV-prevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
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Liegler T, Abdel-Mohsen M, Bentley LG, Atchison R, Schmidt T, Javier J, Mehrotra M, Eden C, Glidden DV, McMahan V, Anderson PL, Li P, Wong JK, Buchbinder S, Guanira JV, Grant RM. HIV-1 drug resistance in the iPrEx preexposure prophylaxis trial. J Infect Dis 2014; 210:1217-27. [PMID: 24740633 PMCID: PMC4176446 DOI: 10.1093/infdis/jiu233] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The iPrEx study demonstrated that combination oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) as preexposure prophylaxis (PrEP) protects against HIV acquisition in men who have sex with men and transgender women. Selection for drug resistance could offset PrEP benefits. METHODS Phenotypic and genotypic clinical resistance assays characterized major drug resistant mutations. Minor variants with FTC/TDF mutations K65R, K70E, M184V/I were measured using 454 deep sequencing and a novel allele-specific polymerase chain reaction (AS-PCR) diagnostic tolerant to sequence heterogeneity. RESULTS Control of primer-binding site heterogeneity resulted in improved accuracy of minor variant measurements by AS-PCR. Of the 48 on-study infections randomized to FTC/TDF, none showed FTC/TDF mutations by clinical assays despite detectable drug levels in 8 participants. Two randomized to FTC/TDF had minor variant M184I detected at 0.53% by AS-PCR or 0.75% by deep sequencing, only 1 of which had low but detectable drug levels. Among those with acute infection at randomization to FTC/TDF, M184V or I mutations that were predominant at seroconversion waned to background levels within 24 weeks after discontinuing drug. CONCLUSIONS Drug resistance was rare in iPrEx on-study FTC/TDF-randomized seroconverters, and only as low-frequency minor variants. FTC resistance among those initiating PrEP with acute infection waned rapidly after drug discontinuation. Clinical Trials Registration.NCT00458393.
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Affiliation(s)
- Teri Liegler
- Department of Medicine, University of California AIDS Research Institute, University of California
| | | | | | | | | | | | | | | | - David V Glidden
- Department of Epidemiology, University of California, San Francisco
| | | | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora
| | - Peilin Li
- Veterans Affairs Medical Center, San Francisco
| | | | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, California
| | | | - Robert M Grant
- Department of Medicine, University of California J. David Gladstone Institutes
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Bogoch II, Scully EP, Zachary KC, Yawetz S, Mayer KH, Bell CM, Andrews JR. Patient Attrition Between the Emergency Department and Clinic Among Individuals Presenting for HIV Nonoccupational Postexposure Prophylaxis. Clin Infect Dis 2014; 58:1618-24. [DOI: 10.1093/cid/ciu118] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Byrne P, MacPherson P, Roy M, Kitson C. Overviewing a Nurse-Led, Community-Based HIV PEP Program: Applying the Extant Literature in Frontline Practice. Public Health Nurs 2014; 32:256-65. [PMID: 24698415 DOI: 10.1111/phn.12123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This clinical concept paper overviews a program to facilitate access to postexposure prophylaxis (PEP) for gay, bisexual, and other men who have sex with men. The project, which was a collaborative initiative involving the local School of Nursing, public health unit, AIDS service organization, hospital-based HIV clinic, and an outpatient pharmacy, was implemented to circumvent common barriers to care identified in the literature. In this project, persons who present to one of the two participating clinics after having come, or likely having come, into contact with HIV within the previous 72 hr, are offered rapid HIV testing, also known as point-of-care (POC) testing, to rule out existing HIV infection, and provided with a follow-up appointment booked at the HIV clinic. Clients are also offered comprehensive STI testing, and HIV prevention counseling. The implementation of this collaborative community-based access-to-PEP project demonstrates the application of research to a real-world health care setting, and it is hoped that others will adapt this model to their local setting, enabling ease of access to PEP for members of groups that are disproportionately affected by HIV.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul MacPherson
- Department of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie Roy
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Kitson
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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48
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McAllister J, Read P, McNulty A, Tong WWY, Ingersoll A, Carr A. Raltegravir-emtricitabine-tenofovir as HIV nonoccupational post-exposure prophylaxis in men who have sex with men: safety, tolerability and adherence. HIV Med 2013; 15:13-22. [DOI: 10.1111/hiv.12075] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J McAllister
- HIV, Immunology & Infectious Diseases Unit; St Vincent's Hospital; Sydney Australia
| | - P Read
- Sydney Sexual Health Centre; Sydney Hospital; Sydney Australia
- The Kirby Institute; University of New South Wales; Sydney Australia
| | - A McNulty
- Sydney Sexual Health Centre; Sydney Hospital; Sydney Australia
- School of Public Health and Community Medicine; University of New South Wales; Sydney Australia
| | - WWY Tong
- HIV, Immunology & Infectious Diseases Unit; St Vincent's Hospital; Sydney Australia
| | - A Ingersoll
- HIV, Immunology & Infectious Diseases Unit; St Vincent's Hospital; Sydney Australia
| | - A Carr
- HIV, Immunology & Infectious Diseases Unit; St Vincent's Hospital; Sydney Australia
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49
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Fernández-Balbuena S, Belza MJ, Castilla J, Hoyos J, Rosales-Statkus ME, Sánchez R, de la Fuente L. Awareness and use of nonoccupational HIV post-exposure prophylaxis among people receiving rapid HIV testing in Spain. HIV Med 2012; 14:252-7. [PMID: 23088284 DOI: 10.1111/j.1468-1293.2012.01056.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis (nPEP) in Spain, and the factors that influence this awareness. METHODS Between June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. RESULTS Some 34% of the responders were men who have sex with men (MSM), 30% were men who have sex exclusively with women (MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. CONCLUSIONS nPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use.
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Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, Nakku-Joloba E, Twesigye R, Ngure K, Apaka C, Tamooh H, Gabona F, Mujugira A, Panteleeff D, Thomas KK, Kidoguchi L, Krows M, Revall J, Morrison S, Haugen H, Emmanuel-Ogier M, Ondrejcek L, Coombs RW, Frenkel L, Hendrix C, Bumpus NN, Bangsberg D, Haberer JE, Stevens WS, Lingappa JR, Celum C. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367:399-410. [PMID: 22784037 PMCID: PMC3770474 DOI: 10.1056/nejmoa1108524] [Citation(s) in RCA: 2407] [Impact Index Per Article: 200.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations. METHODS We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens--once-daily tenofovir (TDF), combination tenofovir-emtricitabine (TDF-FTC), or matching placebo--and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services. RESULTS We enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P=0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study. CONCLUSIONS Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.).
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Affiliation(s)
- Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA 98104, USA.
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