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Lima ÉRG, Queiroz MAF, Lima SS, Machado LFA, Cayres-Vallinoto IMV, Vallinoto ACR, Figueiredo FADPL, Guerreiro JF, Guimarães Ishak MDO, Ishak R. CCR5∆32 and SDF1 3'A: Gene Variants, Expression and Influence on Biological Markers for the Clinical Progression to AIDS among HIV-1 Virus Controllers in a Mixed Population of the Amazon Region of Brazil. Int J Mol Sci 2023; 24:ijms24054958. [PMID: 36902388 PMCID: PMC10003039 DOI: 10.3390/ijms24054958] [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: 12/30/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 03/08/2023] Open
Abstract
CCR5Δ32 and SDF1-3'A polymorphisms were investigated in a cohort of viremia controllers, without the use of therapy, along with their influence on CD4+ T lymphocytes (TLs), CD8+ TLs, and plasma viral load (VL). The samples were analyzed from 32 HIV-1-infected individuals classified as viremia controllers 1 and 2 and viremia non-controllers, from both sexes, mostly heterosexuals, paired with 300 individuals from a control group. CCR5∆32 polymorphism was identified by PCR amplification of a fragment of 189 bp for the wild-type allele and 157 bp for the allele with the ∆32 deletion. SDF1-3'A polymorphism was identified by PCR, followed by enzymatic digestion (restriction fragment length polymorphism) with the Msp I enzyme. The relative quantification of gene expression was performed by real-time PCR. The distribution of allele and genotype frequencies did not show significant differences between the groups. The gene expression of CCR5 and SDF1 was not different between the profiles of AIDS progression. There was no significant correlation between the progression markers (CD4+ TL/CD8+ TL and VL) and the CCR5∆32 polymorphism carrier status. The 3'A allele variant was associated with a marked loss of CD4+ TLs and a higher plasma VL. Neither CCR5∆32 nor SDF1-3'A was associated with viremia control or the controlling phenotype.
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Affiliation(s)
- Érica Ribeiro Gomes Lima
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | - Maria Alice Freitas Queiroz
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
- Correspondence: ; Tel.: +55-91-98864-4259
| | - Sandra Souza Lima
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | | | | | | | | | - João Farias Guerreiro
- Human and Medical Genetics Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Ricardo Ishak
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
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Thomas B, Piron P, de La Rochebrochard E, Segouin C, Troude P. Is HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men Effective in a Real-World Setting? Experience with One-On-One Counseling and Support in a Sexual Health Center in Paris, 2018-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114295. [PMID: 36361171 PMCID: PMC9656100 DOI: 10.3390/ijerph192114295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/04/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' care engagement, which is often mediocre and poorly measured in real-world settings. This study aimed to assess the effectiveness of a PrEP program in a sexual health center that included accompanying measures to improve engagement. A retrospective observational study was conducted. All men who have sex with men (MSM) who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal sexual health center, Paris, France, were included. Among the 125 MSM who initiated PrEP, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of post-exposure prophylaxis. During the first year, patients attended a median of three visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) had a successful PrEP course, assessed by a novel metric. These results highlight the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures and one-on-one counseling by a trained counselor could explain the effectiveness of this PrEP program.
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Affiliation(s)
- Bérenger Thomas
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Prescillia Piron
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Free Sexual Health Center, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Elise de La Rochebrochard
- Institut National d’Etudes Démographiques (INED), 93300 Aubervilliers, France
- CESP U1018, Inserm, UVSQ, Université Paris-Saclay, 94800 Villejuif, France
| | - Christophe Segouin
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Free Sexual Health Center, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Pénélope Troude
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Institut National d’Etudes Démographiques (INED), 93300 Aubervilliers, France
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N’takpé JB, Gabillard D, Moh R, Gardiennet E, Toni TD, Kouame GM, Badje A, Emieme A, Karcher S, Le Carrou J, Ménan H, Danel C, Eholie SP, Rouzioux C, Anglaret X, Lambotte O. Elite and viremic HIV-1 controllers in West Africa. AIDS 2022; 36:29-38. [PMID: 34524145 PMCID: PMC8654265 DOI: 10.1097/qad.0000000000003072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on HIV-1 controllers in Africa are scarce. We report the proportion of HIV-1 controllers in a group of adults prospectively monitored with frequent viral load measurements as part of a clinical trial in West Africa. METHODS For the Temprano trial, antiretroviral therapy (ART)-naive HIV-1 infected adults with no criteria for starting ART were randomized to start ART immediately or defer ART until the WHO starting criteria were met. Plasma viral load was measured every 6 months. The trial follow-up was 30 months. We considered all Temprano participants randomized to defer ART. Patients with all semestrial viral <2000 copies/ml and still off ART at month 30 were defined as HIV-1 controllers. Controllers with all viral loads <50 copies/ml were defined as elite controllers, the rest as viremic controllers. RESULTS Of the 1023 HIV-1-infected adults randomized in the Temprano deferred-ART group, 18 (1.8%) met the criteria for classification as HIV controllers, of whom seven (0.7%) were elite controllers and 11 (1.1%) viremic controllers. The HIV-1 controllers had low peripheral blood mononuclear cell HIV-1 DNA and low inflammatory marker levels. They maintained high CD4+ cell count and percentages and had a low morbidity rate. DISCUSSION HIV controllers exist in Africa at a proportion close to that reported elsewhere. They represent a small fraction of all HIV-1-infected patients but raise important questions. Further studies should assess whether starting ART might represent more risk than benefit for some controllers, and where it does, how to identify these patients before they start ART.
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Affiliation(s)
- Jean Baptiste N’takpé
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- Département de Dermatologie et Maladies Infectieuses, Université Felix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Delphine Gabillard
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
| | - Raoul Moh
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- Département de Dermatologie et Maladies Infectieuses, Université Felix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Elise Gardiennet
- AP-HP, CHU Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Thomas-d’Aquin Toni
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- CeDReS, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Gérard M. Kouame
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- Département de Dermatologie et Maladies Infectieuses, Université Felix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Anani Badje
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- Département de Dermatologie et Maladies Infectieuses, Université Felix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Arlette Emieme
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- CeDReS, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Sophie Karcher
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
| | - Jérome Le Carrou
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
| | - Hervé Ménan
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- CeDReS, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Christine Danel
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
| | - Serge P. Eholie
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
- Département de Dermatologie et Maladies Infectieuses, Université Felix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Christine Rouzioux
- PACCI/ANRS Research Center
- Faculté de Médecine, Université Paris Descartes, Paris
| | - Xavier Anglaret
- Inserm 1219, University of Bordeaux, IRD, Bordeaux, France
- PACCI/ANRS Research Center
| | - Olivier Lambotte
- AP-HP Paris Saclay, Hôpital Bicêtre, Clinical Immunology Department
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IDMIT/IMVA-HB), Le Kremlin Bicêtre, France
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Berg MG, Olivo A, Harris BJ, Rodgers MA, James L, Mampunza S, Niles J, Baer F, Yamaguchi J, Kaptue L, Laeyendecker O, Quinn TC, McArthur C, Cloherty GA. A high prevalence of potential HIV elite controllers identified over 30 years in Democratic Republic of Congo. EBioMedicine 2021; 65:103258. [PMID: 33674212 PMCID: PMC7992073 DOI: 10.1016/j.ebiom.2021.103258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background In-depth analysis of the HIV pandemic at its epicenter in the Congo basin has been hampered by 40 years of political unrest and lack of functional public health infrastructure. In recent surveillance studies (2017-18), we found that the prevalence of HIV in Kinshasa, Democratic Republic of Congo (11%) far exceeded previous estimates. Methods 10,457 participants were screened in Kinshasa with rapid tests from 2017-2019. Individuals confirmed as reactive by the Abbott ARCHITECT HIV Ag/Ab Combo assay (n=1968) were measured by the Abbott RealTime HIV-1 viral load assay. Follow up characterization of samples was performed with alternate manufacturer viral load assays, qPCR for additional blood borne viruses, unbiased next generation sequencing, and HIV Western blotting. Findings Our data suggested the existence of a significant cohort (n=429) of HIV antibody positive/viral load negative individuals. We systematically eliminated collection site bias, sample integrity, and viral genetic diversity as alternative explanations for undetectable viral loads. Mass spectroscopy unexpectedly detected the presence of 3TC antiviral medication in approximately 60% of those tested (209/354), and negative Western blot results indicated false positive serology in 12% (49/404). From the remaining Western blot positives (n=53) and indeterminates (n=31) with reactive Combo and rapid test results, we estimate 2.7-4.3% of infections in DRC to be potential elite controllers. We also analyzed samples from the DRC collected in 1987 and 2001-03, when antiretroviral drugs were not available, and found similarly elevated trends. Interpretation Viral suppression to undetectable viral loads without therapy occurs infrequently in HIV-1 infected patients around the world. Mining of global data suggests a unique ability to control HIV infection arose early in central Africa and occurs in <1% of founder populations. Identification of this group of elite controllers presents a unique opportunity to study potentially novel genetic mechanisms of viral suppression. Funding Abbott Laboratories funded surveillance in DRC and subsequent research efforts. Additional funding was received from a MIZZOU Award from the University of Missouri. Research was supported in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH.
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Affiliation(s)
- Michael G Berg
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States.
| | - Ana Olivo
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | - Barbara J Harris
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | - Mary A Rodgers
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | - Linda James
- Université Protestante au Congo, Croisement de l'avenue de Libération et du Boulevard Triomphal, Kinshasa, Democratic Republic of Congo; IMA World Health, 1730 M St NW Suite 1100, Washington DC, United States
| | - Samuel Mampunza
- Université Protestante au Congo, Croisement de l'avenue de Libération et du Boulevard Triomphal, Kinshasa, Democratic Republic of Congo
| | - Jonathan Niles
- IMA World Health, 1730 M St NW Suite 1100, Washington DC, United States
| | - Franklin Baer
- SANRU NGO, 76 Ave. de la Justice, Kinshasa-Gombe, Democratic Republic of Congo
| | - Julie Yamaguchi
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | | | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Carole McArthur
- Pathology Department, Truman Medical Center, Kansas City, MO, United States; Department of Oral and Craniofacial Sciences, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Gavin A Cloherty
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
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Treister-Goltzman Y, Alhoashle A, Peleg R. Infectious diseases among Ethiopian immigrants in Israel: a descriptive literature review. Pathog Glob Health 2021; 115:224-234. [PMID: 33624575 DOI: 10.1080/20477724.2021.1890888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The mass immigration of Ethiopian Jews to Israel began in the 1980s. For most of these immigrants this was a time of sharp transition from a village life with very basic living conditions, in most cases without a regular supply of water, electricity, or healthcare services, to a modern Western urban society. The aim of this review was to search the medical literature on the characteristics of infectious diseases that are typical in Ethiopian immigrants (EI), using relevant keywords. There has been success in coping with diseases among EI, that are rare although recognized in Israel, in terms of screening and early identification. TB was common in Ethiopia over all the years of immigration to Israel. In contrast, HIV appeared in EI from 1999 when they had long stayovers in transition camps in Gondar and Addis Ababa where there was a high risk of infection with sexually transmitted diseases. There were often delays in diagnosing 'exotic' diseases that are endemic in Africa, but not well known in Israel, such as Onchocerciasis, Schistosomiasis, Strongyloidiasis, and Bartonella endocarditis, which cause severe morbidity and mortality among EI. We describe the effect on general morbidity in Israel, and how the healthcare services coped with these diseases, including obstacles, and failures and successes. In light of the ongoing immigration of African refugees to the United States and Europe, the Israeli experience can be of value to healthcare policy makers in developing strategies for the effective management by medical staff treating these immigrants.
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Affiliation(s)
- Yulia Treister-Goltzman
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Tel Aviv, Israel
| | | | - Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Tel Aviv, Israel
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Twahirwa Rwema JO, Lyons CE, Herbst S, Liestman B, Nyombayire J, Ketende S, Mazzei A, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan PS, Allen S, Karita E, Baral SD. HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study. J Int AIDS Soc 2020; 23 Suppl 6:e25604. [PMID: 33000912 PMCID: PMC7527755 DOI: 10.1002/jia2.25604] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. METHODS MSM and TGW ≥ 18 years were recruited using respondent-driven sampling (RDS) from March-August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. RESULTS A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS-adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV-positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut-off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. CONCLUSIONS These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV-related outcomes for MSM in Rwanda.
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Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Carrie E Lyons
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Benjamin Liestman
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Sosthenes Ketende
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Oluwasolape Olawore
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | | | | | | | | | - Stefan D Baral
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Biggs K, O'Sullivan M, Palmer C, McLellan J, Marple-Clark F, Spinks A, Langton-Lockton J, Thng C. Post-exposure prophylaxis in the era of pre-exposure prophylaxis: a study of post-exposure prophylaxis use in South-East Queensland since the Pharmaceutical Benefits Scheme listing of pre-exposure prophylaxis. Int J STD AIDS 2020; 31:426-431. [PMID: 32192371 DOI: 10.1177/0956462420911579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Both post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) involve the use of antiretroviral drugs taken by HIV-uninfected individuals to reduce HIV acquisition risk. While PEP has been available in Australia for many years, PrEP became widely accessible in 2018 after listing on the Pharmaceutical Benefits Scheme (PBS). Studies have reported on the impact of PrEP on condom use. The impact of PrEP on the use of PEP in Australia has not been reported. This project examined PEP use across three public sexual health services in South-East Queensland, Australia, comparing rates in 2016 (prePBS-listed PrEP) and 2019 (postPBS-listed PrEP), to determine if PEP prescribing, and the characteristics of people accessing PEP, have changed. Results showed that PEP prescribing made up 2.85% of all clients seen in 2016, dropping to 2.33% in 2019, reflecting a decrease of 0.5% (p = 0.048). There was a significant increase in Medicare-ineligible clients accessing PEP (9% in 2016; 21% in 2019; p = 0.002) and a significant increase in PrEP-experienced clients accessing PEP between the two study periods (4% in 2016; 14% in 2019; p ≤ 0.001). The marginal decrease in PEP prescribing highlights that PEP remains an important option especially for those with barriers to accessing and adhering to daily PrEP.
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Affiliation(s)
- Karen Biggs
- Gold Coast Sexual Health Service, Gold Coast Hospital and Health Service, Southport, Australia
| | - Maree O'Sullivan
- Gold Coast Sexual Health Service, Gold Coast Hospital and Health Service, Southport, Australia
| | - Cheryn Palmer
- PA Sexual Health, Princess Alexandra Hospital, Metro South Health Service, Woolloongabba, Australia
| | - Jacqualine McLellan
- Sexual Health & HIV Service, Metro North Health Service, Brisbane, Australia
| | - Fiona Marple-Clark
- Gold Coast Sexual Health Service, Gold Coast Hospital and Health Service, Southport, Australia
| | - Adam Spinks
- Sexual Health & HIV Service, Metro North Health Service, Brisbane, Australia
| | | | - Caroline Thng
- Gold Coast Sexual Health Service, Gold Coast Hospital and Health Service, Southport, Australia
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Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage. AIDS 2020; 34:631-636. [PMID: 31794520 DOI: 10.1097/qad.0000000000002453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood. DESIGN Post hoc analysis of nationally representative household survey to compare alternative biomarker-based adjustments to population HIV indicators. METHODS We reclassified HIV-positive participants aged 15-64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) who were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/ml) on dried blood spots. We compared self-report to adjustments for ARV measurement, UVL, or both. RESULTS Treatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4-47.8] based on ARV detection alone, to 42.8% (95% CI 37.9-47.8) when ARV-adjusted, 46.2% (95% CI 41.3-51.1) when UVL-adjusted and 48.8% (95% CI 43.9-53.8) when adjusted for either ARV or UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7-61.6) when ARV-adjusted, 57.5% (95% CI 51.9-63.0) when UVL-adjusted, and 59.8% (95% CI 54.2-65.1) when adjusted for either ARV or UVL. CONCLUSION Undetectable viral load, which is routinely measured in surveys, may be a useful adjunct or alternative to ARV detection for adjusting survey estimates of knowledge of HIV status and antiretroviral treatment coverage.
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