1
|
Godinez H, Xu Q, McMann TJ, Li J, Mackey TK. Analysis of online user discussions on Reddit associated with the transition of use between HIV PrEP therapy. Front Public Health 2023; 11:1073813. [PMID: 37457283 PMCID: PMC10338828 DOI: 10.3389/fpubh.2023.1073813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
In 2019, the U.S. Food and Drug Administration (FDA) approved emtricitabine and tenofovir alafenamide (Descovy) as another option for HIV pre-exposure prophylaxis (PrEP) prevention for high-risk adults and adolescents. With the introduction of this new PrEP, millions of current users on emtricitabine and tenofovir disoproxil fumarate (Truvada), another PrEP medication currently used to prevent HIV transmission, have options of whether to continue their current treatment regime or transition to new treatment options. The objective of this study was to conduct a descriptive analysis to characterize user-generated social media conversations on Reddit associated with FDA-approved PrEP prevention treatment options. Key themes identified were associated with perceptions, knowledge, and attitudes associated with the transition of use of different PrEP medications. Data were collected retrospectively and prospectively from the Reddit platform for posts with keywords filtered for HIV, PrEP, and FDA-approved PrEP prevention treatment from October 2020 to December 2020. We chose the Reddit platform based on prior studies that have identified PrEP user conversations and insights on access challenges for specific AIDS communities, such as gays and men who have sex with men (MSM). Reddit posts were then manually annotated using an inductive content coding approach for key themes regarding the transition of use and other emergent themes from user-generated content. Formal coding of text data was conducted with refined codes, and sub-codes created. A total of 3,120 posts were analyzed from Reddit resulting in 315 posts that were coded for PrEP and 105 posts (33.33%) specific to user discussions regarding the transition of PrEP prevention. Overall, users expressed interest in drug switching to Descovy, particularly in the context of poorer adherence or concerns about existing side effects associated with Truvada. Other major themes included discussions about the cost of Descovy, apprehension about side effects in comparison to Truvada, insurance coverage changes, and discussions about the donation of Truvada to other users after transitioning. Among these discussions, topics related to sexual minorities, including MSM, reported concerns when considering a switch in their HIV prevention regime. Understanding the changing public perception associated with the introduction of new HIV prevention is important in the context of market access, patient safety, pharmacovigilance, and health equity, particularly among high-risk populations such as MSM. Results support the use of social media from a digital pharmacovigilance perspective to better understand emerging HIV prevention, treatment, and adherence challenges experienced by patients.
Collapse
Affiliation(s)
| | - Qing Xu
- S-3 Research, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Tiana J. McMann
- Global Health Policy and Data Institute, San Diego, CA, United States
- Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA, United States
| | - Jiawei Li
- S-3 Research, San Diego, CA, United States
| | - Timothy Ken Mackey
- S-3 Research, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
2
|
Dickson S, Gabriel N, Hernandez I. Estimated changes in price discounts for tenofovir-inclusive HIV treatments following introduction of tenofovir alafenamide. AIDS 2022; 36:2225-2227. [PMID: 36205353 PMCID: PMC9698192 DOI: 10.1097/qad.0000000000003401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022]
Abstract
We estimated list and net prices for tenofovir disoproxil fumarate (TDF) products Truvada, Complera, and Stribild, and their tenofovir alafenamide (TAF) versions Descovy, Odefsey, and Genvoya. Gilead offered discounts for Descovy that resulted into lower net prices compared to Truvada. This strategy encouraged patients switching from Truvada to Descovy before the availability of generic Truvada. Conversely, Gilead offered lower discounts for Odefsey and Genvoya, which resulted into higher net prices compared to Complera and Stribild.
Collapse
Affiliation(s)
| | - Nico Gabriel
- Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | - Inmaculada Hernandez
- Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| |
Collapse
|
3
|
Lagi F, Botta A, Kiros ST, Meli M, Borchi B, Cavallo A, Pozzi M, Bartoloni A, Sterrantino G. Comparison of the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC or DTG/ABC/3TC in virologically-suppressed HIV-1-infected patients in a single Italian centre: a cohort data analysis. Int J Antimicrob Agents 2021; 59:106465. [PMID: 34699933 DOI: 10.1016/j.ijantimicag.2021.106465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
This study evaluated the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC (RPV-STR) or DTG/ABC/3TC (DTG-STR) in virologically-suppressed HIV-positive patients in a single Italian centre. All HIV-infected ART-experienced patients switching to RPV-STR or DTG-STR with HIV-RNA <50 copies/mL were included. Outcomes were incidence rate and rate ratios for discontinuation due to all causes (DAC), to adverse events (DAE) and to virological failure (VF) after 4 years of follow-up. We included 402 patients (244 on RPV-STR, 158 on DTG-STR). At Year 4 of follow-up, 124 patients (30.8%) discontinued for any cause (71 on RPV-STR, 53 on DTG-STR). Fifteen patients experienced VF [13 (5.3%) on RPV-STR and 2 (1.3%) on DTG-STR; log-rank, P = 0.4413]. Overall, 46 patients (11.4%) had AEs (23 on RPV-STR, 23 on DTG-STR). Nausea/diarrhoea was more frequent with DTG-STR (4.4% vs. 0%) and neurological toxicity with RPV-STR (4.5% vs. 2.5%). The rate of DAC within the first 3 months was significantly higher with DTG-STR (aRR = 5.88, 95% CI 3.20-10.81; P < 0.001); similarly, the discontinuation rate due to AEs was significantly higher with DTG-STR compared with RPV-STR (aRR = 12.89, 95% CI 5.48-30.32; P < 0.001). No difference in VF was observed between the two groups (RR = 0.47, 95% CI 0.10-2.14; P = 0.335). Patients with undetectable viral load who switched to DTG-STR or RPV-STR maintained virological suppression with a low risk of VF. A higher discontinuation rate was observed with DTG-STR compared with RPV-STR, particularly within 3 months from switch.
Collapse
Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Meli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| |
Collapse
|
4
|
Serrano PA, Daubert E, Munoz A, Hosek SG, French AL. Effect of Truvada lawsuit advertising on preexposure prophylaxis attitudes and decisions among sexual and gender minority youth and young adults at risk for HIV. AIDS 2021; 35:131-139. [PMID: 33031102 PMCID: PMC7718403 DOI: 10.1097/qad.0000000000002728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In 2019, US advocates reported misleading language regarding the safety of TDF/FTC (Truvada) used by lawsuit advertisements against Gilead Sciences. We sought to ascertain the reach and effects of the advertisements on preexposure prophylaxis (PrEP) opinions and decisions in a cohort of youth and young adults at-risk for HIV. DESIGN An online survey was administered to participants enrolled in Keeping it LITE, a prospective US cohort study of ethnically diverse, sexually active, cisgender and transgender persons ages 13-37. METHODS Quantitative data were analyzed using descriptive and inferential analysis in SAS, and qualitative data via thematic analysis. RESULTS Survey response rate was 51.3% (n = 1485). Mean age at baseline was 24. Previous PrEP use was reported by 43% of respondents and 32.7% reported PrEP use in the past 6 months. Almost half (48.7%) were aware of the lawsuit. Most of these participants (81.3%) reported the advertisements did not impact their PrEP use, but 13.2% decided to not to begin a Truvada-based PrEP regimen and 5.5% decided to stop taking Truvada due to the advertisements claims. Predictors of changing PrEP behavior were lower education and no previous PrEP use. The qualitative analysis revealed the advertisements increased skepticism about safety and benefit of Truvada PrEP and led to greater distrust of the pharmaceutical industry. CONCLUSION The advertisements reached a large, diverse US audience. Disturbingly, 18.7% of PrEP candidates who were aware of the lawsuit attributed not initiating or cessation of a Truvada-based PrEP regimen to exposure to the Truvada lawsuit advertisements.
Collapse
Affiliation(s)
| | | | | | - Sybil G. Hosek
- Ruth M Rothstein CORE Center, Chicago, IL USA
- John H. Jr, Stroger Hospital of Cook County, Chicago, IL USA
| | - Audrey L. French
- Ruth M Rothstein CORE Center, Chicago, IL USA
- John H. Jr, Stroger Hospital of Cook County, Chicago, IL USA
| |
Collapse
|
5
|
Mayer KH, Molina JM, Thompson MA, Anderson PL, Mounzer KC, De Wet JJ, DeJesus E, Jessen H, Grant RM, Ruane PJ, Wong P, Ebrahimi R, Zhong L, Mathias A, Callebaut C, Collins SE, Das M, McCallister S, Brainard DM, Brinson C, Clarke A, Coll P, Post FA, Hare CB. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet 2020; 396:239-254. [PMID: 32711800 PMCID: PMC9665936 DOI: 10.1016/s0140-6736(20)31065-5] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tenofovir alafenamide shows high antiviral efficacy and improved renal and bone safety compared with tenofovir disoproxil fumarate when used for HIV treatment. Here, we report primary results from a blinded phase 3 study evaluating the efficacy and safety of pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir alafenamide versus emtricitabine and tenofovir disoproxil fumarate for HIV prevention. METHODS This study is an ongoing, randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial done at 94 community, public health, and hospital-associated clinics located in regions of Europe and North America, where there is a high incidence of HIV or prevalence of people living with HIV, or both. We enrolled adult cisgender men who have sex with men and transgender women who have sex with men, both with a high risk of acquiring HIV on the basis of their self-reported sexual behaviour in the past 12 weeks or their recent history (within 24 weeks of enrolment) of bacterial sexually transmitted infections. Participants with current or previous use of PrEP with emtricitabine and tenofovir disoproxil fumarate were not excluded. We used a computer-generated random allocation sequence to randomly assign (1:1) participants to receive either emtricitabine (200 mg) and tenofovir alafenamide (25 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir alafenamide group), or emtricitabine (200 mg) and tenofovir disoproxil fumarate (300 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir disoproxil fumarate group). As such, all participants were given two tablets. The trial sponsor, investigators, participants, and the study staff who provided the study drugs, assessed the outcomes, and collected the data were masked to group assignment. The primary efficacy outcome was incident HIV infection, which was assessed when all participants had completed 48 weeks of follow-up and half of all participants had completed 96 weeks of follow-up. This full analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug and had at least one post-baseline HIV test. Non-inferiority of emtricitabine and tenofovir alafenamide to emtricitabine and tenofovir disoproxil fumarate was established if the upper bound of the 95·003% CI of the HIV incidence rate ratio (IRR) was less than the prespecified non-inferiority margin of 1·62. We prespecified six secondary bone mineral density and renal biomarker safety endpoints to evaluate using the safety analysis set. This analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug. This trial is registered with ClinicalTrials.gov, NCT02842086, and is no longer recruiting. FINDINGS Between Sept 13, 2016, and June 30, 2017, 5387 (92%) of 5857 participants were randomly assigned and received emtricitabine and tenofovir alafenamide (n=2694) or emtricitabine and tenofovir disoproxil fumarate (n=2693). At the time of the primary efficacy analysis (ie, when all participants had completed 48 weeks and 50% had completed 96 weeks) emtricitabine and tenofovir alafenamide was non-inferior to emtricitabine and tenofovir disoproxil fumarate for HIV prevention, as the upper limit of the 95% CI of the IRR, was less than the prespecified non-inferiority margin of 1·62 (IRR 0·47 [95% CI 0·19-1·15]). After 8756 person-years of follow-up, 22 participants were diagnosed with HIV, seven participants in the emtricitabine and tenofovir alafenamide group (0·16 infections per 100 person-years [95% CI 0·06-0·33]), and 15 participants in the emtricitabine and tenofovir disoproxil fumarate group (0·34 infections per 100 person-years [0·19-0·56]). Both regimens were well tolerated, with a low number of participants reporting adverse events that led to discontinuation of the study drug (36 [1%] of 2694 participants in the emtricitabine and tenofovir alafenamide group vs 49 [2%] of 2693 participants in the emtricitabine and tenofovir disoproxil fumarate group). Emtricitabine and tenofovir alafenamide was superior to emtricitabine and tenofovir disoproxil fumarate in all six prespecified bone mineral density and renal biomarker safety endpoints. INTERPRETATION Daily emtricitabine and tenofovir alafenamide shows non-inferior efficacy to daily emtricitabine and tenofovir disoproxil fumarate for HIV prevention, and the number of adverse events for both regimens was low. Emtricitabine and tenofovir alafenamide had more favourable effects on bone mineral density and biomarkers of renal safety than emtricitabine and tenofovir disoproxil fumarate. FUNDING Gilead Sciences.
Collapse
Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jean-Michel Molina
- Infectious Diseases Department, Hopitaux Saint-Louis Lariboisière, University of Paris and INSERM U944, Paris, France
| | | | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | | | | | | | | | - Robert M Grant
- San Francisco AIDS Foundation, and University of California, San Francisco, CA, USA
| | - Peter J Ruane
- Ruane Medical and Liver Health Institute, Los Angeles, CA, USA
| | - Pamela Wong
- Department of Biometrics, Gilead Sciences, Foster City, CA, USA
| | - Ramin Ebrahimi
- Department of Biometrics, Gilead Sciences, Foster City, CA, USA
| | - Lijie Zhong
- Department of Biometrics, Gilead Sciences, Foster City, CA, USA
| | - Anita Mathias
- Department of Clinical Pharmacology, Gilead Sciences, Foster City, CA, USA
| | | | - Sean E Collins
- Department of HIV and Emerging Viral Infections Clinical Research, Gilead Sciences, Foster City, CA, USA
| | - Moupali Das
- Department of HIV and Emerging Viral Infections Clinical Research, Gilead Sciences, Foster City, CA, USA.
| | - Scott McCallister
- Department of HIV and Emerging Viral Infections Clinical Research, Gilead Sciences, Foster City, CA, USA
| | - Diana M Brainard
- Department of HIV and Emerging Viral Infections Clinical Research, Gilead Sciences, Foster City, CA, USA
| | | | - Amanda Clarke
- Royal Sussex County Hospital, Brighton and Sussex University Hospitals National Health Service (NHS) Trust, Brighton, UK
| | - Pep Coll
- BCN Checkpoint and IrsiCaixa-AIDS Research Institute, Barcelona, Spain
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - C Bradley Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| |
Collapse
|
6
|
Ojeda VD, Amico KR, Hughes JP, Wilson E, Li M, Holtz TH, Chitwarakorn A, Grant RM, Dye B, Bekker LG, Mannheimer S, Marzinke M, Hendrix CW. Low Disclosure of PrEP Nonadherence and HIV-Risk Behaviors Associated With Poor HIV PrEP Adherence in the HPTN 067/ADAPT Study. J Acquir Immune Defic Syndr 2019; 82:34-40. [PMID: 31169769 PMCID: PMC6698708 DOI: 10.1097/qai.0000000000002103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the relationship between 2 types of social relationships, ie, (1) external support for use of HIV pre-exposure prophylaxis (PrEP) and related study supplies and (2) participants' disclosure of PrEP use and condom use and HIV PrEP adherence among daily-dosing regimen participants in HIV Prevention Trials Network (HPTN) 067, an open-label trial of oral tenofovir (TFV) disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg. METHODS Using HPTN 067 survey data, we developed scales examining (1) Low Perceived External Support for PrEP: low perceived support by others for PrEP use or perceived negative reactions to the pill case (scoring ranges from 0 to 2) and (2) Participant-Staff Disclosure Challenges Scale, which identifies challenges to sharing nonuse of PrEP or condoms to study staff (scoring ranges from 0 to 4); these scales are the primary independent variables. Adherence, the dependent variable, was determined using log-transformed plasma TFV concentrations. generalized estimating equation (GEE) linear regression was used to assess the association between both scales and adherence. RESULTS Participants (n = 161) included HIV-uninfected women in South Africa, and men who have sex with men and transgender women, in Thailand and the United States. In multivariable analyses, higher scores in the Participant-Staff Disclosure Challenges Scale were significantly associated with lower PrEP adherence [exp(β) = 0.62, 95% CI: (0.46 to 0.84); P = 0.002] as were increased days since the last PrEP dose [exp(β) = 0.73, 95% CI: (0.65 to 0.83); P ≤ 0.001]. CONCLUSIONS Given the association with adherence, study staff-participant interactions and participants' disclosure of PrEP challenges may be worthwhile intervention targets for improving PrEP adherence in confirmatory studies.
Collapse
Affiliation(s)
- Victoria D. Ojeda
- Department of Medicine, UCSD School of Medicine, La Jolla,
California, United States
| | - K. Rivet Amico
- Department of Health Behavior and Health Education,
University of Michigan, Ann Arbor, Michigan, United States
| | - James P. Hughes
- Department of Biostatistics, University of Washington,
Seattle, Washington, United States
| | - Ethan Wilson
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Maoji Li
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Timothy H. Holtz
- Thailand Ministry of Public Health – U.S. Centers
for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease
Control and Prevention, Atlanta, Georgia, United States
| | | | - Robert M. Grant
- Gladstone Institutes, University of California, San
Francisco, California, United States
| | - Bonnie Dye
- HIV Prevention Trials Network, FHI 360, Durham, North
Carolina, United States
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town,
Cape Town, South Africa
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital Center, New
York, New York, United States
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, New York, United States
- ICAP, Columbia University Mailman School of Public
Health, New York, New York, United States
| | - Mark Marzinke
- Dept. of Pathology, Johns Hopkins University School of
Medicine, Baltimore, MD USA
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
7
|
|
8
|
Affiliation(s)
- J-L Schmutz
- Département de dermatologie et allergologie, hôpital de Brabois, CHRU, bâtiment des spécialités médicales Philippe-Canton, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
| |
Collapse
|
9
|
Heendeniya A, Tumarkin E, Bogoch II. HIV preexposure prophylaxis in Canadian primary care and community settings. Can Fam Physician 2019; 65:271-272. [PMID: 30979761 PMCID: PMC6467657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Ethan Tumarkin
- Completing residency in internal medicine, University of Toronto in Ontario
| | - Isaac I Bogoch
- Associate Professor in the Department of Medicine at the University of Toronto, a staff physician in the Division of Internal Medicine and Infectious Diseases with the University Health Network in Toronto, and the lead physician at the HIV Prevention Clinic at Toronto General Hospital
| |
Collapse
|
10
|
Torjesen I. Some men who were unable to access PrEP through NHS trial are now HIV positive, charities report. BMJ 2019; 364:l299. [PMID: 30659018 DOI: 10.1136/bmj.l299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
11
|
Desrosiers A, Levy M, Dright A, Zumer M, Jallah N, Kuo I, Magnus M, Siegel M. A Randomized Controlled Pilot Study of a Culturally-Tailored Counseling Intervention to Increase Uptake of HIV Pre-exposure Prophylaxis Among Young Black Men Who Have Sex with Men in Washington, DC. AIDS Behav 2019; 23:105-115. [PMID: 30171452 DOI: 10.1007/s10461-018-2264-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Daily emtricitabine/tenofovor is effective at preventing HIV acquisition and is approved for HIV pre-exposure prophylaxis (PrEP). Blacks in the United States have a disproportionately high rate of HIV, and uptake of PrEP has been very low in this population. We conducted a pilot study in a high-prevalence city to test whether a culturally-tailored counseling center for young Black men who have sex with men (BMSM) positively impacted their access and uptake of PrEP. 50 young BMSM were randomized to either a PrEP counseling center group or a control group, and were then encouraged to obtain PrEP from a PrEP provider. At the end of 3 month study, six participants in the intervention group compared with none in the control group had initiated PrEP (p = 0.02). This pilot study demonstrates that a culturally-tailored counseling center might be an effective at increasing the uptake of PrEP in young BMSM.
Collapse
Affiliation(s)
- Aimee Desrosiers
- Division of Infectious Disease, Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Suite 8-436, Washington, DC, 20037, USA
| | - Matthew Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, 20052, USA
| | - Aurnell Dright
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, 20052, USA
| | - Maria Zumer
- Division of Infectious Disease, Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Suite 8-436, Washington, DC, 20037, USA
| | - Nikardi Jallah
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, 20052, USA
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, 20052, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, 20052, USA
| | - Marc Siegel
- Division of Infectious Disease, Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Suite 8-436, Washington, DC, 20037, USA.
| |
Collapse
|
12
|
Buttram ME. The informal use of antiretroviral medications for HIV prevention by men who have sex with men in South Florida: initiation, use practices, medications and motivations. Cult Health Sex 2018; 20:1185-1198. [PMID: 29360420 DOI: 10.1080/13691058.2017.1421709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Limited data suggest that some gay and other men who have sex with men are using antiretroviral medications informally, without a prescription, for HIV prevention. This qualitative study examined this phenomenon among gay and other men who have sex with men in South Florida. Participants initiated informal antiretroviral medication use as a means of protecting each other and because of the confidence in knowledge of antiretroviral medications shared by their friends and sex partners. The most commonly used medications included Truvada and Stribild. Motivations for use included condom avoidance, risk reduction, and fear of recent HIV exposure. Participants described positive and negative sentiments related to informal use, including concerns about informal antiretroviral medications offering sufficient protection against HIV, and limited knowledge about pre-exposure prophylaxis (PrEP). Because the antiretroviral medications used for PrEP have the potential to prevent HIV infection, future research must consider the informal antiretroviral medication use and related concerns, including adherence, diversion and viral resistance.
Collapse
Affiliation(s)
- Mance E Buttram
- a Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA
| |
Collapse
|
13
|
Fisher CB, Fried AL, Ibrahim Puri L, Macapagal K, Mustanski B. "Free Testing and PrEP without Outing Myself to Parents:" Motivation to participate in oral and injectable PrEP clinical trials among adolescent men who have sex with men. PLoS One 2018; 13:e0200560. [PMID: 30044845 PMCID: PMC6059443 DOI: 10.1371/journal.pone.0200560] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent men who have sex with men (AMSM) account for disproportionately high numbers of new HIV diagnoses. Non-adherence to daily use limiting the effectiveness of oral PrEP (Truvada) has led to current trials with adult MSM testing Cabotegravir, a long-term injectable medication. Once comparative studies with young adult MSM have established relative safety and efficacy of these medications, there will be a need for such comparative trials involving adolescents. Trends in state laws and IRB protocol review indicate that many of these studies will permit youth to provide independent consent for participation. Understanding the motivations of AMSM to participate in HIV biomedical prevention studies is important to ensure their agreement is voluntary without misunderstanding and undue influence. This study examined AMSM attitudes toward participation in oral/injectable PrEP RCTs to inform protections of youth's rights and welfare in future studies. METHODS We administered to 198 ethnically diverse U.S. AMSM, 14-17 years, a web-based survey including demographic and sexual health questions, description of a year-long oral versus injectable PrEP RCT and 26 Likert-type and one open-ended item assessing motivations for and against participation including: perceived benefits and risks of PrEP; free HIV/STI testing and counseling; confidentiality concerns; random assignment; and benefit to others. RESULTS Sixty-two percent indicated they were likely to participate in the study. The majority endorsed daily HIV protection, free HIV/STI testing, sexual health counseling, not having to rely on partner's condom use, and altruism as reasons to participate. Reasons against participation included medication side effects, concern taking the pill daily and clinic visits would reveal their sexual orientation and behaviors to parents. Over half erroneously assumed they would be assigned to the condition best for them and 39% indicated free access to services would lead them to participate even if they did not want to. Multiple regression indicated these factors accounted for 55% of the variance in participation choice. Nether age or ethnicity yielded significance. CONCLUSIONS Results suggest future biomedical HIV prevention research will need to develop procedures to address AMSM's confidentiality concerns, enhance youth's understanding of random assignment, the continued importance of medication adherence and partner condom use during trial participation, and availability of alternative sexual health services to avoid the potentially undue influence of access to free sexual health services.
Collapse
Affiliation(s)
- Celia B. Fisher
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Adam L. Fried
- Clinical Psychology Department, Midwestern University, Glendale, Arizona, United States of America
| | - Leah Ibrahim Puri
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Kathryn Macapagal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| |
Collapse
|
14
|
Barreiro P. Sexually Transmitted Infections on the Rise in PrEP Users. AIDS Rev 2018; 20:71. [PMID: 29628512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pre-exposure prophylaxis (PrEP) with oral Truvada (tenofovir plus emtricitabine) is effective at preventing HIV infection in high-risk homosexual men. In the United States, PrEP was approved in 2012 and is reimbursed by Medicaid and the majority of private insurers. The situation is diverse and not uniform in the European Union, being PrEP more widely used in France than in the rest of countries. Concerns have been raised that PrEP use may be accompanied by the phenomena of risk compensation or behavioral disinhibition, whereby PrEP users' perception of decreased risk of HIV acquisition may lead them to engage in overall riskier sexual practices and increase their chances of acquiring sexually transmitted infections (STIs) (Blumenthal, et al. Virtual Mentor. 2014;16:909-15). Modifiable factors that may influence the acquisition of STI include condom use, number of partners, partner characteristics, and healthcare-seeking behaviors. In addition, MSM may alter HIV risk mitigation practices while on PrEP by decreasing seroadaptive practices such as serosorting that is seeking a partner of similar perceived serostatus (Khosopour, et al. AIDS Behav. 2017;21:2935-44). High rates of STI have been reported among PrEP users, as well as high rates of condomless sex, and increasing rates of STI over time (Liu, et al. JAMA Intern Med. 2016;176:75-84; Kojima, et al. AIDS, 2016;30:2251-2). In a new study conducted in Montreal, Canada, increases in the rates of STI in PrEP users were demonstrated measuring incidence rates of STI before and following the initiation of PrEP in the same cohort. The authors measured the incidence of gonorrhea, chlamydia, and/or syphilis in 109 HIV-seronegative homosexual men 12 months before and 12 months after beginning Truvada for HIV prevention (Nguyen, et al. AIDS. 2018;32:523-30). New episodes of gonorrhea, chlamydia, and/or syphilis rose in the cohort after providing Truvada, as shown in Figure 1. Moreover, the incidence of three or more STI increased from 3.7 to 9.2 cases per 100 personyears in this cohort. The Canadian study highlighted that the rate of STI with PrEP was also higher than in a group of 86 homosexual men that had undergone PEP in Montreal during 2010-2015. Other findings of the study we the high rate of STI with anorectal location, symptomless STI (e.g., chlamydia) and the frequency of sex partners contacted by internet. The increased rates of STI in PrEP users suggest a need to reinforce counseling and STI diagnosis and treatment efforts. Although PrEP may provide a public health benefit beyond the immediate prevention of HIV infection as result of bringing into care high-risk homosexual men who might not otherwise be seeking care for STI, doctors in charge must take this opportunity for informing adequately on STI and the risks inherent to multiple and occasional sexual contacts.
Collapse
|
15
|
Abstract
Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
Collapse
Affiliation(s)
- Monica Desai
- HIV and STI Department, Public Health England, London NW9 5EQ, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, University College London, London WC1E 6BT, UK
| | - Robert Grant
- University of California School of Medicine; Gladstone Institutes; San Francisco AIDS Foundation, San Francisco, CA 94115, USA
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London
- Chelsea and Westminster Hospital, London SW10 9BH
| |
Collapse
|
16
|
Abstract
The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.
Collapse
Affiliation(s)
- Eliza Govender
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
- b Centre for Culture, Communication and Media Studies (CCMS), College of Humanities , University of KwaZulu-Natal , Durban , South Africa
| | - Leila Mansoor
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
| | - Kate MacQueen
- c Social and Behavioural Health Sciences, FHI 360 , Durham , NC , USA
| | - Quarraisha Abdool Karim
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
- d Department of Epidemiology , Columbia University , New York , NY , USA
| |
Collapse
|
17
|
Abstract
The pre-exposure prophylaxis (PrEP) drug Truvada is a new HIV prevention technology that is predominantly promoted as relevant to HIV-negative gay men. This paper explores what PrEP represents for HIV-positive gay men living in Paris, based upon data collected through interviews and ethnographic research. While HIV-positive gay men do not directly consume Truvada through PrEP, they nonetheless hold opinions and understandings of this drug, specifically as it relates to their own sexuality. This paper expands the representations and meanings of this new technology in a different light through the voices of gay men living with HIV in Paris. The main argument of this article is that PrEP as an additional HIV prevention tool blurs the lines between science, technologies and human sexuality.
Collapse
Affiliation(s)
- Julien Brisson
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
| | - Vinh-Kim Nguyen
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW The review describes the evidence for HIV preexposure prophylaxis (PrEP) with daily combined tenofovir disoproxil fumarate and emtricitabine for adolescents and young adults. Current recommendations are described, as are the unique medical, socioeconomic, and legal considerations regarding the use of PrEP for youth. RECENT FINDINGS PrEP with daily oral tenofovir disoproxil fumarate-emtricitabine has been shown to help prevent new HIV infection among adults at substantial risk. Evidence suggests a protective benefit of PrEP for youth at risk for HIV, although low adherence is emerging as a barrier to effective use. SUMMARY Effective use of antiretrovirals for PrEP represents a seminal development in HIV prevention efforts. Improving access and adherence to PrEP for youth has the potential to substantially reduce the incidence of HIV in this population.
Collapse
Affiliation(s)
- Emily B. Allen
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allegra Gordon
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas Krakower
- Fenway Health, The Fenway Institute, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
19
|
Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men. AIDS Behav 2017; 21:1236-1246. [PMID: 28108878 DOI: 10.1007/s10461-017-1690-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.
Collapse
Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA.
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Devon Price
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Stephanie Finneran
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Aerielle Allen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica Maksut
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
20
|
|
21
|
Abstract
On May 14, 2014 the Centers for Disease Control and Prevention (CDC) endorsed the drug Truvada as an HIV preventative, called pre-exposure prophylaxis (PrEP). PrEP has been shown to dramatically reduce the risk of HIV infection, but its rate of adoption has been slow, and discourse surrounding it has been marked by stigma and uncertainty. The purpose of this study was to investigate how PrEP was discussed on Twitter. Our analysis focused on barriers to PrEP adoption and stigmatization of PrEP users. We analyzed a random sample of 1,093 top tweets about PrEP posted to Twitter a year before and a year after the CDC's endorsement. Our results showed that tweets likely reinforced uncertainty about barriers to PrEP adoption and that users employed Twitter's functionality to counter stigmatizing narratives about PrEP. We suggest that our findings illuminate both the limitations and strengths of Twitter as a mechanism for health promotion.
Collapse
Affiliation(s)
- Joseph Schwartz
- a Department of Communication Studies , Northeastern University
| | - Josh Grimm
- b Manship School of Mass Communication , Louisiana State University
| |
Collapse
|
22
|
Affiliation(s)
| | | | - P Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | |
Collapse
|
23
|
Montgomery ET, Mensch B, Musara P, Hartmann M, Woeber K, Etima J, van der Straten A. Misreporting of Product Adherence in the MTN-003/VOICE Trial for HIV Prevention in Africa: Participants' Explanations for Dishonesty. AIDS Behav 2017; 21:481-491. [PMID: 27858268 DOI: 10.1007/s10461-016-1609-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Consistent over-reporting of product use limits researchers' ability to accurately measure adherence and estimate product efficacy in HIV prevention trials. While lying is a universal characteristic of the human condition, growing evidence of a stark discrepancy between self-reported product use and biologic or pharmacokinetic evidence demands examination of the reasons research participants frequently misrepresent product use in order to mitigate this challenge in future research. This study (VOICE-D) was an ancillary post-trial study of the vaginal and oral interventions to control the epidemic (VOICE) phase IIb trial (MTN 003). It was conducted in three African countries to elicit candid accounts from former VOICE trial participants about why actual product use was lower than reported. In total 171 participants were enrolled between December 2012 and March 2014 in South Africa (n = 47), Uganda (n = 59) and Zimbabwe (n = 65). Data suggested that participants understood the importance of daily product use and honest reporting, yet acknowledged that research participants typically lie. Participants cited multiple reasons for misreporting adherence, including human nature, self-presentation with study staff, fear of repercussions (study termination resulting in loss of benefits and experience of HIV-related stigma), a permissive environment in which it was easy to get away with misreporting, and avoiding inconvenient additional counseling. Some participants also reported mistrust of the staff and reciprocal dishonesty about the study products. Many suggested real-time blood-monitoring during trials would encourage greater fidelity to product use and honesty in reporting. Participants at all sites understood the importance of daily product use and honesty, while also acknowledging widespread misreporting of product use. Narratives of dishonesty may suggest a wider social context of hiding products from partners and distrust about research, influenced by rumors circulating in clinic waiting-rooms and surrounding communities. Prevailing power hierarchies between staff and participants may exacerbate misreporting. Participants recognized and suggested that objective, real-time feedback is needed to encourage honest reporting.
Collapse
Affiliation(s)
- Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA.
| | - B Mensch
- Population Council, New York, NY, USA
| | - P Musara
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - M Hartmann
- Women's Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA
| | - K Woeber
- HIV Prevention Research Unit, South Africa Medical Research Council, Durban, South Africa
| | - J Etima
- Johns Hopkins University Research Unit, Makerere University, Kampala, Uganda
| | - A van der Straten
- Women's Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA
- Center for AIDS Prevention Studies, Department of Medicine, UCSF, Mission Bay, San Francisco, CA, 94105, USA
| |
Collapse
|
24
|
Arae H, Tateyama M, Nakamura H, Tasato D, Kami K, Miyagi K, Maeda S, Uehara H, Moromi M, Nakamura K, Fujita J. Evaluation of the Lipid Concentrations after Switching from Antiretroviral Drug Tenofovir Disoproxil Fumarate/Emtricitabine to Abacavir Sulfate/Lamivudine in Virologically-suppressed Human Immunodeficiency Virus-infected Patients. Intern Med 2016; 55:3435-3440. [PMID: 27904105 PMCID: PMC5216139 DOI: 10.2169/internalmedicine.55.7518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 11/06/2022] Open
Abstract
Objective Recently, tenofovir disoproxil fumatate (TDF)-related side effects, such as renal nephrotoxicity and reduction of bone mineral density, have been reported. Consequently, increased switching from fixed-dose tablet TDF and emtricitabine (TDF/FTC) to abacavir and lamivudine (ABC/3TC) has occurred. Interestingly, while TDF has a lipid-lowering property, one of the ABC-related side effects is hyperlipidemia. Therefore, such switching could cause lipid elevation. To evaluate the change in lipid levels associated with switching from TDF/FTC to ABC/3TC in virologically-suppressed human immunodeficiency virus (HIV)-infected patients. Methods This is a retrospective, single-center study. We included the HIV-infected patients whose therapy included a drug switch from TDF/FTC to ABC/3TC between September 2009 and December 2012 at Ryukyu University Hospital. The exclusion criteria were HIV-RNA >40 copies/mL on the switching day, and a documented therapy change to a lipid-lowering agent or any other antiretroviral agents within 3 months before or after switching. We compared the low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) levels before switching to three months after. Results A total of 18 patients met the inclusion criteria. The LDL, HDL, and TC levels significantly increased three months following the switch (p<0.05), with median (interquartile range) values of 17 (7, 32), 6 (2, 13), and 27 (10, 45) mg/dL, respectively. The TG values did not markedly change. Conclusion Switching from TDF/FTC to ABC/3TC resulted in significantly increased LDL, HDL, and TC levels.
Collapse
Affiliation(s)
- Hirotaka Arae
- Department of Pharmacy, Ryukyu University Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The purpose of this study was to analyze the frequency of incidents of uncertainty in online news articles about Truvada, a drug used to prevent HIV infection. Using a coding scheme that synthesized uncertainty research from health disciplines and communication studies, we analyzed 235 articles from the most-read United States-based news websites. Our results showed that 80.4% of articles contained at least one incident of uncertainty, that articles contained significantly more incidents of uncertainty before the Centers for Disease Control and Prevention (CDC) endorsed Truvada compared to after the CDC endorsed the drug, and that articles mentioning men who have sex with men (MSM) contained significantly more incidents of uncertainty than articles in which they were not mentioned.
Collapse
Affiliation(s)
- Joseph Schwartz
- a Department of Communication Studies , Northeastern University
| | - Josh Grimm
- b Manship School of Mass Communication , Louisiana State University
| |
Collapse
|
26
|
|
27
|
Red. [EMA examines an application for change in authorization of truvada]. MMW Fortschr Med 2016; 158 Suppl 1:58. [PMID: 27259906 DOI: 10.1007/s15006-016-8335-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
28
|
Affiliation(s)
- David T Dunn
- MRC Clinical Trials Unit, University College London, London WC2B 6NH, UK.
| | - Mitzy Gafos
- MRC Clinical Trials Unit, University College London, London WC2B 6NH, UK
| | - Ellen White
- MRC Clinical Trials Unit, University College London, London WC2B 6NH, UK
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London WC2B 6NH, UK
| |
Collapse
|
29
|
Affiliation(s)
- Robert M Grant
- Gladstone Institutes, San Francisco, CA, USA; University of California, San Francisco, CA, USA; San Francisco AIDS Foundation, San Francisco, CA, USA.
| | | |
Collapse
|
30
|
Petroll AE, Staden RA, Westergaard RP. Pre-exposure Prophylaxis in Primary Care--A New Era in HIV Prevention. WMJ 2016; 115:6-8. [PMID: 27057572 PMCID: PMC6612244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
31
|
Blondel N. [HIV pre-exposure prophylaxis does not increase the rate of STI]. Rev Med Suisse 2016; 12:236. [PMID: 26939198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
32
|
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey CJ, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo SH, Rooney J, Nardone A, Fisher M, McOwan A, Phillips AN, Johnson AM, Gazzard B, Gill ON. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387:53-60. [PMID: 26364263 PMCID: PMC4700047 DOI: 10.1016/s0140-6736(15)00056-2] [Citation(s) in RCA: 1309] [Impact Index Per Article: 163.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. METHODS PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). FINDINGS We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64-96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3-11·3). 13 men (90% CI 9-23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. INTERPRETATION In this high incidence population, daily tenofovir-emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. FUNDING MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.
Collapse
Affiliation(s)
- Sheena McCormack
- MRC Clinical Trials Unit at UCL, London, UK; 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | | | - Monica Desai
- MRC Clinical Trials Unit at UCL, London, UK; HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
| | | | | | - Richard Gilson
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK; Research Department of Infection and Population Health, University College London, London, UK
| | - Ann K Sullivan
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Nicola Mackie
- St Mary's Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christine Bowman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charles J Lacey
- York Teaching Hospital and Hull York Medical School, University of York, York, UK
| | - Vanessa Apea
- Ambrose King Centre and Barts Sexual Health Centre, Barts Health NHS Trust, London, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen Taylor
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simone Antonucci
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Anthony Nardone
- HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
| | - Martin Fisher
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alan McOwan
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Brian Gazzard
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Owen N Gill
- HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
| |
Collapse
|
33
|
Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA.
| | - Chris Beyrer
- Department of Epidemiology, Center for Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; The International AIDS Society, Geneva, Switzerland
| |
Collapse
|
34
|
Nau JY. [HIV: France authorizes and fully reimburses Truvada prophylaxis]. Rev Med Suisse 2015; 11:2302-2303. [PMID: 26785529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
35
|
Nau JY. [Miscellaneous - profound coma, smoking and AIDS]. Rev Med Suisse 2015; 11:2202-2203. [PMID: 26742249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
36
|
McCausland MR, Juchnowski SM, Zidar DA, Kuritzkes DR, Andrade A, Sieg SF, Lederman MM, Funderburg NT. Altered Monocyte Phenotype in HIV-1 Infection Tends to Normalize with Integrase-Inhibitor-Based Antiretroviral Therapy. PLoS One 2015; 10:e0139474. [PMID: 26430882 PMCID: PMC4591977 DOI: 10.1371/journal.pone.0139474] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/14/2015] [Indexed: 12/31/2022] Open
Abstract
Background Monocytes are increasingly implicated in the inflammatory consequences of HIV-1 disease, yet their phenotype following antiretroviral therapy (ART) initiation is incompletely defined. Here, we define more completely monocyte phenotype both prior to ART initiation and during 48 weeks of ART. Methods Cryopreserved peripheral blood mononuclear cells (PBMCs) were obtained at baseline (prior to ART initiation) and at weeks 12, 24, and 48 of treatment from 29 patients participating in ACTG clinical trial A5248, an open label study of raltegravir/emtricitibine/tenofovir administration. For comparison, cryopreserved PBMCs were obtained from 15 HIV-1 uninfected donors, each of whom had at least two cardiovascular risk factors. Thawed samples were stained for monocyte subset markers (CD14 and CD16), HLA-DR, CCR2, CX3CR1, CD86, CD83, CD40, CD38, CD36, CD13, and CD163 and examined using flow cytometry. Results In untreated HIV-1 infection there were perturbations in monocyte subset phenotypes, chiefly a higher frequency and density (mean fluorescence intensity–MFI) of HLA-DR (%-p = 0.004, MFI-p = .0005) and CD86 (%-p = 0.012, MFI-p = 0.005) expression and lower frequency of CCR2 (p = 0.0002) expression on all monocytes, lower CCR2 density on inflammatory monocytes (p = 0.045) when compared to the expression and density of these markers in controls’ monocytes. We also report lower expression of CX3CR1 (p = 0.014) on patrolling monocytes at baseline, compared to levels seen in controls. After ART, these perturbations tended to improve, with decreasing expression and density of HLA-DR and CD86, increasing CCR2 density on inflammatory monocytes, and increasing expression and density of CX3CR1 on patrolling monocytes. Conclusions In HIV-1 infected patients, ART appears to attenuate the high levels of activation (HLA-DR, CD86) and to increase expression of the chemokine receptors CCR2 and CX3CR1 on monocyte populations. Circulating monocyte phenotypes are altered in untreated infection and tend to normalize with ART; the role of these cells in the inflammatory environment of HIV-1 infection warrants further study.
Collapse
Affiliation(s)
- Marie R. McCausland
- Division of Infectious Disease, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Steven M. Juchnowski
- Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - David A. Zidar
- Division of Infectious Disease, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adriana Andrade
- Department of Medicine, Division of Infectious Diseases, John Hopkins University, Baltimore, Maryland, United States of America
| | - Scott F. Sieg
- Division of Infectious Disease, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Michael M. Lederman
- Division of Infectious Disease, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail:
| | - Nicholas T. Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio, United States of America
| |
Collapse
|
37
|
Affiliation(s)
- Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E 7152, Baltimore, MD 21205, USA.
| |
Collapse
|
38
|
Abstract
HIV pre-exposure prophylaxis (PrEP) is a prevention technology that involves prescribing antiretroviral drugs to HIV-negative people to protect them from infection. This paper considers how the development of the technology has necessitated the parallel configuration of its users, and how this process has affected the perception and uptake of the technology. In designing a technology, potential users are typically defined, enabled and constrained, partly to create a target population (or market) for the technology, but also to reassure people that it can be used safely and effectively. This process may or may not be helpful for the uptake and use of the technology. Published research on PrEP indicates that while the technology was under trial, the primary focus was on the 'at-risk' subject in need of PrEP, with little or no consideration of the other qualities necessary for successful use. Post-trial accounts of PrEP have begun to outline desirable qualities of successful PrEP use, such as caution, compliance and being organised. It appears that the PrEP user was only partially configured during the technology's development, and the initial focus on risk has done little to counter fears of the technology, which may partially account for its slow uptake.
Collapse
Affiliation(s)
- Martin Holt
- a Centre for Social Research in Health, UNSW , Australia
| |
Collapse
|