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Sevelius JM, Glidden DV, Deutsch M, Welborn L, Contreras A, Salinas A, Venegas L, Grant RM. Uptake, Retention, and Adherence to Pre-exposure Prophylaxis (PrEP) in TRIUMPH: A Peer-Led PrEP Demonstration Project for Transgender Communities in Oakland and Sacramento, California. J Acquir Immune Defic Syndr 2021; 88:S27-S38. [PMID: 34757990 PMCID: PMC8579996 DOI: 10.1097/qai.0000000000002808] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND TRIUMPH (Trans Research-Informed communities United in Mobilization for the Prevention of HIV) was a community-led, transgender-specific pre-exposure prophylaxis (PrEP) demonstration project at 2 community-based clinical sites in California. TRIUMPH used peer health education, community mobilization, and clinical integration of PrEP with hormone therapy to promote PrEP knowledge and acceptability. The goal of this study was to evaluate PrEP uptake, retention, and adherence among TRIUMPH participants and examine site-based differences. METHODS Eligible participants were adult transgender and gender diverse people interested in PrEP. Participants were seen at baseline and at 1, 3, 6, 9, and 12 months for PrEP provision, clinical visits, and HIV testing. PrEP uptake was defined as dispensation of PrEP, PrEP retention was defined as proportion of expected visits completed among those who initiated PrEP, and PrEP adherence was assessed by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models quantified the association of variables with PrEP outcomes. RESULTS TRIUMPH enrolled 185 participants; the median age was 28 years (interquartile range: 23-35), 7% was Black, and 58% was Latinx. PrEP uptake was as follows: 78% in Oakland and 98% in Sacramento; 91% among trans women, 96% among trans men, and 70% among nonbinary participants. Almost half (47%) rarely/never believed about HIV, and 42% reported condomless sex act in the past 3 months. Participants who reported higher numbers of sex partners were more likely to be retained and adherent; other predictors of adherence included not having a primary partner and not experiencing violence in the past 3 months. CONCLUSIONS This community-led, trans-specific PrEP demonstration project documents high levels of PrEP initiation in a young transgender and gender diverse cohort at risk of HIV acquisition.
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Grant RM, Pellegrini M, Defechereux PA, Anderson PL, Yu M, Glidden DV, O’Neal J, Yager J, Bhasin S, Sevelius J, Deutsch MB. Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study. Clin Infect Dis 2021; 73:e2117-e2123. [PMID: 32766890 PMCID: PMC8492111 DOI: 10.1093/cid/ciaa1160] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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] [Received: 03/31/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sex hormone and preexposure prophylaxis (PrEP) drug interactions among transgender women (TGW), transgender men (TGM), and cisgender men (CGM) are not fully understood. METHODS TGM and TGW on at least 6 months of stable sex hormone therapy containing testosterone or estradiol (respectively) were enrolled in a 4-week study of directly observed dosing of daily oral coformulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). TFV-DP in dried blood spots and sex hormones in serum were measured at weekly intervals. TFV-DP was compared with 2- and 4-week samples from Directly Observed Therapy Dried Blood Spots (DOT-DBS) Study (NCT02022657). RESULTS From May 2017 to June 2018, 24 TGM and 24 TGW were enrolled. Testosterone (total and free) and estradiol concentrations were comparable before and after 4 weeks of PrEP use in TGM and TGW, respectively. Historical controls included 17 cisgender women (CGW) and 15 CGM. TFV-DP concentrations at week 4 were comparable between TGW and TGM (mean difference, -6%; 95% confidence interval [CI], -21% to 12%; P = .47), comparable between TGW and CGM (mean difference, -12%; 95% CI, -27% to 7%; P = .21) and were lower among TGM compared with CGW (mean difference, -23%; 95% CI, -36% to -7%; P = .007). All persons in all groups were projected to reach the TFV-DP threshold that has been associated with high protection from human immunodeficiency virus. CONCLUSIONS CGM, TGM, and TGW had comparable TFV-DP concentrations in dried blood spots after 4 weeks of directly observed daily FTC/TDF PrEP use. Serum hormone concentrations were not affected by FTC/TDF PrEP use. CLINICAL TRIALS REGISTRATION NCT04050371.
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Affiliation(s)
- Robert M Grant
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | | | - Patricia A Defechereux
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Yu
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California, USA
| | - Joshua O’Neal
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Jenna Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jae Sevelius
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
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Ibrahim ME, Glidden DV, Grant RM, Anderson PL. Letter to the Editor: Revisiting the Pharmacological Forgiveness of HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses 2021; 37:407-408. [PMID: 33913746 PMCID: PMC8213004 DOI: 10.1089/aid.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mustafa E. Ibrahim
- Department of Pharmaceutical Sciences and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David V. Glidden
- University of California San Francisco, San Francisco, California, USA
| | - Robert M. Grant
- University of California San Francisco, San Francisco, California, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Address correspondence to: Peter L. Anderson, PharmD, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, V20–C238, Room 4101, 12850 E. Montview Boulevard, Aurora, CO 80045, USA
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Spinelli MA, Lowery B, Shuford JA, Spindler J, Kearney MF, McFarlane JR, McDonald C, Okochi H, Phung N, Kuncze K, Jee K, Johannessen D, Anderson PL, Smith DK, Defechereux P, Grant RM, Gandhi M. Use of Drug-level Testing and Single-genome Sequencing to Unravel a Case of Human Immunodeficiency Virus Seroconversion on Pre-exposure Prophylaxis. Clin Infect Dis 2021; 72:2025-2028. [PMID: 32686825 PMCID: PMC8315126 DOI: 10.1093/cid/ciaa1011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 04/29/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023] Open
Abstract
Cases of seroconversion on pre-exposure prophylaxis (PrEP) should be carefully investigated, given their public health implications and rarity. We report a case of transmitted drug resistance causing seroconversion on PrEP in spite of high adherence, confirmed with dried blood spot and segmental hair drug-level testing and single-genome sequencing.
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Affiliation(s)
- Matthew A Spinelli
- Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | | | - Jon Spindler
- Human Immunodeficiency Virus Dynamics and Replication Program, National Cancer Institute/National Institutes of Health, Ft. Worth, Texas, USA
| | - Mary F Kearney
- Human Immunodeficiency Virus Dynamics and Replication Program, National Cancer Institute/National Institutes of Health, Ft. Worth, Texas, USA
| | | | - Cheryl McDonald
- Texas Centers for Infectious Disease Associates, Ft. Worth, Texas, USA
| | - Hideaki Okochi
- Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nhi Phung
- Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Karen Kuncze
- Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathryn Jee
- Division of Pulmonary Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Dawn K Smith
- Division of Human Immunodeficiency Virus/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia Defechereux
- Division of Pulmonary Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Robert M Grant
- Division of Pulmonary Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Correspondence: M. Gandhi, 995 Potrero Avenue, Ward 84, San Francisco, CA 94110 ()
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O'Keefe KJ, Pipkin S, Fatch R, Scheer S, Liegler T, McFarland W, Grant RM, Truong HHM. Non-B variants of HIV-1 in San Francisco, California. Infect Genet Evol 2021; 90:104677. [PMID: 33321227 PMCID: PMC10686190 DOI: 10.1016/j.meegid.2020.104677] [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] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
The HIV-1 epidemic in the US has historically been dominated by subtype B. HIV subtype diversity has not been extensively examined in most US cities to determine whether non-B variants have become established, as has been observed in many other global regions. We describe the diversity of non-B variants and present evidence of local transmission of non-B HIV in San Francisco. Viral sequences collected from patients between 2000 and 2016 were matched to the San Francisco HIV/AIDS case registry. HIV subtype was determined using COMET. Phylogenies were reconstructed using the pol region of subtypes A, C, D, G, CRF01_AE, CRF02_AG, and CRF07_BC, with reference sequences from the LANL HIV database. Associations of non-B subtypes and circulating recombinant forms (CRFs) with patient characteristics were assessed using multivariable logistic regression. Out of 11,381 sequences, 10,669 were from 7235 registry cases, of which 141 (2%) had non-B subtypes and CRFs and 72 (1%) had unique recombinant forms. CRF01_AE (0.8%) and subtype C (0.5%) were the most prevalent non-B forms. The frequency of non-B subtypes and CRFs increased in San Francisco during years 2000-2016. Out of 146 transmission events involving non-B study sequences, 18% indicated local transmission within the study population and 74% appeared to be inward migration of the virus. Compared to 7016 cases with only subtype B, 141 cases with non-B sequences were more likely to be of non-US country of birth (aOR = 11.02; p < 0.001), of Asian/Pacific-Islander race/ethnicity (aOR = 3.17; p < 0.001), and diagnosed after 2009 (aOR = 4.81; p < 0.001). Results suggest that most non-B infections were likely acquired outside the US and that local transmission of non-B forms has occurred but so far has not produced extensive transmission networks. Thus, non-B variants were not widely established in San Francisco, an observation that differs from cities worldwide with more diverse epidemics.
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Affiliation(s)
- Kara J O'Keefe
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
| | - Sharon Pipkin
- Department of Public Health, San Francisco, CA 94102, USA.
| | - Robin Fatch
- Department of Epidemiology and Biostatistics, University of California, San Francisco 94158, USA.
| | - Susan Scheer
- Department of Public Health, San Francisco, CA 94102, USA.
| | - Teri Liegler
- Department of Medicine, University of California, San Francisco, CA 94158, USA
| | - Willi McFarland
- Department of Public Health, San Francisco, CA 94102, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco 94158, USA.
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
| | - Hong-Ha M Truong
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
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Abstract
In the United States, uptake of daily oral pre-exposure prophylaxis (PrEP) to prevent HIV
continues to grow albeit at a slower than desired pace. Innovations in PrEP delivery
systems may partially address structural challenges related to PrEP uptake and PrEP
persistence, such as difficulty in attending clinic visits or completing laboratory
testing. To study PrEP services offered by a telehealth company called Nurx, we conducted
31 in-depth interviews with prospective or current patients. We hypothesized that patients
would find the quarterly laboratory monitoring requirements to be onerous especially in
light of receiving all other aspects of PrEP care through a telehealth delivery system.
However, interviewees characterized navigating laboratory systems as relatively easy and
complying with the quarterly monitoring as a supplementary benefit of PrEP use. Our
research illustrates that quarterly monitoring requirements are meaningful to some
telehealth PrEP users and may facilitate persistent engagement in receipt of PrEP
care.
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Affiliation(s)
- Kimberly A Koester
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Shana D Hughes
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, CA, USA
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Truong HHM, Mehrotra ML, Grant RM. Brief Report: Seroadaptive Behaviors Varied Among Geographically Diverse iPrEx Participants. J Acquir Immune Defic Syndr 2021; 86:e43-e47. [PMID: 33093331 DOI: 10.1097/qai.0000000000002551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seroadaptive behaviors refer to a wide range of harm reduction practices to decrease HIV transmission risk. Effective implementation of seroadaptive behaviors is dependent on knowledge of one's own serostatus and that of one's sexual partners. Partner-level and environmental-level attributes may affect seroadaptation practices. We assessed factors associated with seroadaptive behaviors. METHODS Men who have sex with men and transgender women were recruited from an HIV pre-exposure prophylaxis clinical trial (iPrEx) with study sites in the US, Peru, Ecuador, Brazil, Thailand, and South Africa. Partnership-level data were collected at the baseline visit for the 3 most recent partners. Participants were considered to have practiced seroadaptive behaviors if: (1) they believed their partner to be HIV-negative, that is, serosorting; or (2) no condomless receptive sex occurred with an HIV-positive or unknown status partner, that is, seropositioning. RESULTS Of 2331 participants, 41% always practiced seroadaptive behaviors, 36% sometimes did, and 23% never did. Participants enrolled at study sites in the US (P < 0.001) and Peru/Ecuador (P < 0.001) were more likely to practice seroadaptive behaviors, whereas transgender women were less likely to do so (P < 0.001). Seroadaptive behaviors were more likely to occur in relationships with steady partners (P = 0.005) and emotionally close relationships (P = 0.013). CONCLUSIONS Seroadaptive behaviors were more frequently observed among iPrEx participants from the US, Peru, and Ecuador study sites and among participants in relationships with partners who they were more committed to and felt emotionally close to. Our findings suggest that seroadaptive behaviors may be influenced by social norms that vary geographically and culturally.
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Affiliation(s)
| | - Megha L Mehrotra
- Epidemiology and Biostatistics, University of California, San Francisco, CA
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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.
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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
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Hughes SD, Koester KA, Engesaeth E, Hawkins MV, Grant RM. Human Enough: Client Experience with Internet-based Access to Pre- Exposure Prophylaxis and the Mechanics of Satisfaction (Preprint). J Med Internet Res 2020; 23:e22650. [PMID: 36256828 PMCID: PMC8406118 DOI: 10.2196/22650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/16/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shana D Hughes
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Kimberly A Koester
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Robert M Grant
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Dimitrov D, Moore JR, Wood D, Mitchell KM, Li M, Hughes JP, Donnell DJ, Mannheimer S, Holtz TH, Grant RM, Boily MC. Predicted Effectiveness of Daily and Nondaily Preexposure Prophylaxis for Men Who Have Sex With Men Based on Sex and Pill-taking Patterns From the Human Immuno Virus Prevention Trials Network 067/ADAPT Study. Clin Infect Dis 2020; 71:249-255. [PMID: 31437276 PMCID: PMC7353329 DOI: 10.1093/cid/ciz799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 03/20/2019] [Accepted: 08/14/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The HIV Prevention Trials Network (HPTN) 067/Alternative Dosing to Augment PrEP Pill Taking (ADAPT) Study evaluated the feasibility of daily and nondaily human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) regimens among high-risk populations, including men who have sex with men (MSM) and transgender women, in Bangkok, Thailand and Harlem, New York. We used a mathematical model to predict the efficacy and effectiveness of different dosing regimens. METHODS An individual-based mathematical model was used to simulate annual HIV incidence among MSM cohorts. PrEP efficacy for covered sex acts, as defined in the HPTN 067/ADAPT protocol, was estimated using subgroup efficacy estimates from the preexposure prophylaxis initiative (iPrEx) trial. Effectiveness was estimated by comparison of the HIV incidence with and without PrEP use. RESULTS We estimated that PrEP was highly protective (85%-96% efficacy across regimens and sites) for fully covered acts. PrEP was more protective for partially covered acts in Bangkok (71%-88% efficacy) than in Harlem (62%-81% efficacy). Our model projects 80%, 62%, and 68% effectiveness of daily, time-driven, and event-driven PrEP for MSM in Harlem compared with 90%, 85%, and 79% for MSM in Bangkok. Halving the efficacy for partially covered acts decreases effectiveness by 8-9 percentage points in Harlem and by 5-9 percentage points in Bangkok across regimens. CONCLUSIONS Our analysis suggests that PrEP was more effective among MSM in Thailand than in the United States as a result of more fully covered sex acts and more pills taken around partially covered acts. Overall, nondaily PrEP was less effective than daily PrEP, especially in the United States where the sex act coverage associated with daily use was substantially higher.
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Affiliation(s)
- Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
- Department of Applied Mathematics, University of Washington, Seattle
| | - James R Moore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | - Daniel Wood
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | - Kate M Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Maoji Li
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | - James P Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Deborah J Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | - Sharon Mannheimer
- Harlem Hospital and Mailman School of Public Health, Columbia University, New York
| | - Timothy H Holtz
- Human Immuno Virus/Sexually transmitted diseases Research Program, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi
- Division of Human Immuno Virus/AIDS Prevention, US CDC, Atlanta, Georgia
| | - Robert M Grant
- School of Medicine, University of California, San Francisco
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
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11
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Velloza J, Heffron R, Amico KR, Rowhani-Rahbar A, Hughes JP, Li M, Dye BJ, Celum C, Bekker LG, Grant RM. The Effect of Depression on Adherence to HIV Pre-exposure Prophylaxis Among High-Risk South African Women in HPTN 067/ADAPT. AIDS Behav 2020; 24:2178-2187. [PMID: 31955360 DOI: 10.1007/s10461-020-02783-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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
Oral pre-exposure prophylaxis (PrEP) is highly efficacious but low adherence undermines effectiveness. Depression, common in African women, may be a barrier to consistent PrEP use. We aimed to assess the relationship between depression, psychosocial mediators, and PrEP adherence among South African women. We analyzed data from 174 South African women in HPTN 067, an open-label oral PrEP trial conducted from 2011 to 2013. Participants were followed for 24 weeks. PrEP adherence was measured via Wisepill™ and weekly self-report interview data. We considered participants "adherent" at week 24 if Wisepill™ and interviews indicated that ≥ 80% of expected doses were taken in the prior month. Elevated depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression (CES-D) scale. We used marginal structural models to estimate the effect of elevated symptoms at baseline on PrEP adherence at week 24 and to assess whether the direct effect changed meaningfully after accounting for mediating effects of stigma, social support, and PrEP optimism. High PrEP adherence occurred less often among women with elevated depressive symptoms (N = 35; 44.3%) compared with those without (N = 52; 54.7%; adjusted relative risk [aRR]: 0.79; 95% confidence interval [CI] 0.63-0.99). The effect of elevated depressive symptoms on PrEP adherence persisted in models accounting for the mediating influence of stigma (aRR: 0.74; 95% CI 0.51-0.97) and PrEP optimism (aRR: 0.75; 95% CI 0.55-0.99). We also found a direct effect of similar magnitude and direction when accounting for social support as the mediating variable, although this adjusted relative risk estimate was not statistically significant (aRR: 0.77; 95% CI 0.57-1.03). Depressive symptoms were common and associated with lower PrEP adherence among South African women. Future work is needed to determine whether depression services integrated with PrEP delivery could improve PrEP effectiveness among African women.
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Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
- International Clinical Research Center, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - James P Hughes
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Robert M Grant
- University of California at San Francisco, San Francisco, CA, USA
- Gladstone Institute of Virology and Immunology, University of California at San Francisco, San Francisco, CA, USA
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12
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Ascher SB, Scherzer R, Estrella MM, Shigenaga J, Spaulding KA, Glidden DV, Mehrotra ML, Defechereux P, Gandhi M, Grant RM, Shlipak MG, Jotwani V. HIV preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and changes in kidney function and tubular health. AIDS 2020; 34:699-706. [PMID: 31794523 PMCID: PMC7071971 DOI: 10.1097/qad.0000000000002456] [Citation(s) in RCA: 9] [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: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effects of HIV preexposure prophylaxis (PrEP) with tenofovir disoproxial fumurate (TDF)/emtricitabine (FTC) on kidney function and kidney tubular health. DESIGN The Iniciativa Profilaxis Pre-Exposicion open-label extension (iPrEx-OLE) study enrolled former PrEP trial participants to receive open-label TDF/FTC. This study included 123 iPrEx-OLE participants who demonstrated PrEP adherence. METHODS We compared estimated glomerular filtration rate calculated using serum creatinine (eGFRcr), serum cystatin C (eGFRcys), and in combination (eGFRcr-cys), and a panel of 14 urine biomarkers reflecting kidney tubular health before and 6 months after PrEP initiation. RESULTS At baseline, mean eGFRcr, eGFRcys, and eGFRcr-cys were 108.3, 107.0, and 111.1 ml/min per 1.73 m, respectively. Six months after PrEP initiation, eGFRcr declined by -4% (95% CI: -5.7 to -2.4%), eGFRcys declined by -3.3% (95% CI: -8.3 to 1.9%), and eGFRcr-cys declined by -4.1% (95% CI: -7.5 to -0.7%). From the urine biomarker panel, α1-microglobulin and β2-microglobulin increased by 22.7% (95% CI: 11.8--34.7%) and 14.1% (95% CI: -6.1 to 38.6%), whereas chitinase-3-like 1 protein and monocyte chemoattractant protein-1 decreased by -37.7% (95% CI: -53.0 to -17.3%) and -15.6% (95% CI: -31.6 to 4.2%), respectively. Ten of the 14 urine biomarkers, including albumin, had estimated changes of less than 12% with wide confidence intervals. CONCLUSION Six months of PrEP with TDF/FTC was associated with decreases in eGFRcr and eGFRcys. We also observed for the first time changes in flour of 14 urine biomarkers reflecting kidney tubular health. These findings demonstrate that PrEP has direct effects on eGFR and the proximal tubule.
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Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
- Department of Medicine, University of California, Davis, Sacramento
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
| | - Judy Shigenaga
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
| | - Kimberly A Spaulding
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
| | | | | | | | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine
| | - Robert M Grant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco
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13
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Lopez MI, Grant RM, Dong BJ. Community pharmacy delivered PrEP to STOP HIV transmission: An opportunity NOT to miss! J Am Pharm Assoc (2003) 2020; 60:e18-e24. [PMID: 32165026 DOI: 10.1016/j.japh.2020.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 02/03/2023]
Abstract
In the United States, 1.1 million persons are living with human immunodeficiency virus (HIV), and approximately 37,800 new infections occur annually. Ending the HIV epidemic requires reducing HIV transmissions by 90% within the next 10 years and requires expanded HIV testing, antivirals for persons infected with HIV, and scale-up of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) to prevent new infections. Community pharmacies are widely accessible and employ highly trained health care professionals on-site who can initiate PrEP and PEP. Recommendations are offered to implement a community pharmacy PrEP program. Pharmacy, government, and HIV prevention leaders must be prepared to support and promote transformative changes, including (1) modification or expansion of existing state-specific scope of practice to initiate PrEP and PEP, (2) encouraging pharmacist education about PrEP and PEP, (3) identification and screening of candidates for PrEP eligibility, (4) incorporating pharmacy laboratory ordering and monitoring logistics, (5) adjusting workflow and ensuring confidential spaces for sensitive discussions, and (6) addressing reimbursement to maintain pharmacist-delivered PrEP and PEP programs. HIV disproportionately affects minority communities and younger individuals who may not be engaged in the health care system. Community pharmacies are accessible and can help increase PrEP use. Expansion of community pharmacy PrEP programs are needed to help end the HIV epidemic. Implementation of PrEP requires adaptation of the pharmacy profession to support incorporation of PrEP in a community pharmacy. Endorsement and support of community pharmacists are needed to implement PrEP to increase HIV prevention efforts and expand pharmacists' scope of practice.
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14
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Dong BJ, Lopez MI, Grant RM. Response to: Acceptability and Feasibility of a Pharmacist-Led HIV Pre-exposure Prophylaxis Program in the Midwestern United States. Open Forum Infect Dis 2019; 6:ofz497. [PMID: 31824977 PMCID: PMC6892568 DOI: 10.1093/ofid/ofz497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Betty J Dong
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Maria I Lopez
- Department of Clinical Services, Mission Wellness Pharmacy, San Francisco, California, USA
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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15
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Colby DJ, Kroon E, Sacdalan C, Gandhi M, Grant RM, Phanuphak P, Ananworanich J, Robb ML, Phanuphak N. Acquisition of Multidrug-Resistant Human Immunodeficiency Virus Type 1 Infection in a Patient Taking Preexposure Prophylaxis. Clin Infect Dis 2019; 67:962-964. [PMID: 29961859 PMCID: PMC6117447 DOI: 10.1093/cid/ciy321] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
We report a case indicating that acquisition of multidrug-resistant human immunodeficiency (HIV) virus type 1 during preexposure prophylaxis with combination tenofovir disoproxil fumarate and emtricitabine or evolution of resistance after HIV seroconversion remains a risk.
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Affiliation(s)
- Donn J Colby
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Eugene Kroon
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | | | | | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Merlin L Robb
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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16
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Grant RM, Mannheimer S, Hughes JP, Hirsch-Moverman Y, Loquere A, Chitwarakorn A, Curlin ME, Li M, Amico KR, Hendrix CW, Anderson PL, Dye BJ, Marzinke MA, Piwowar-Manning E, McKinstry L, Elharrar V, Stirratt M, Rooney JF, Eshleman SH, McNicholl JM, van Griensven F, Holtz TH. Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study. Clin Infect Dis 2019; 66:1712-1721. [PMID: 29420695 DOI: 10.1093/cid/cix1086] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/24/2018] [Indexed: 11/14/2022] Open
Abstract
Background Nondaily dosing of oral preexposure prophylaxis (PrEP) may provide equivalent coverage of sex events compared with daily dosing. Methods At-risk men and transgender women who have sex with men were randomly assigned to 1 of 3 dosing regimens: 1 tablet daily, 1 tablet twice weekly with a postsex dose (time-driven), or 1 tablet before and after sex (event-driven), and were followed for coverage of sex events with pre- and postsex dosing measured by weekly self-report, drug concentrations, and electronic drug monitoring. Results From July 2012 to May 2014, 357 participants were randomized. In Bangkok, the coverage of sex events was 85% for the daily arm compared with 84% for the time-driven arm (P = .79) and 74% for the event-driven arm (P = .02). In Harlem, coverage was 66%, 47% (P = .01), and 52% (P = .01) for these groups. In Bangkok, PrEP medication concentrations in blood were consistent with use of ≥2 tablets per week in >95% of visits when sex was reported in the prior week, while in Harlem, such medication concentrations occurred in 48.5% in the daily arm, 30.9% in the time-driven arm, and 16.7% in the event-driven arm (P < .0001). Creatinine elevations were more common in the daily arm (P = .050), although they were not dose limiting. Conclusions Daily dosing recommendations increased coverage and protective drug concentrations in the Harlem cohort, while daily and nondaily regimens led to comparably favorable outcomes in Bangkok, where participants had higher levels of education and employment. Clinical Trials Registration NCT01327651.
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Affiliation(s)
- Robert M Grant
- Gladstone Institutes, University of California, San Francisco AIDS Foundation
| | - Sharon Mannheimer
- Harlem Hospital and Mailman School of Public Health, Columbia University, New York, New York
| | - James P Hughes
- University of Washington, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Avelino Loquere
- ICAP, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Marcel E Curlin
- Thailand Ministry of Public Health, Nonthaburi.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | | | | | | | | | | | | | - Janet M McNicholl
- Thailand Ministry of Public Health, Nonthaburi.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Frits van Griensven
- Thai Red Cross AIDS Research Center, Bangkok.,Division of Preventive Medicine, University of California, San Francisco
| | - Timothy H Holtz
- Thailand Ministry of Public Health, Nonthaburi.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Holtz TH, Chitwarakorn A, Hughes JP, Curlin ME, Varangrat A, Li M, Amico KR, Mock PA, Grant RM. HPTN 067/ADAPT: Correlates of Sex-Related Pre-exposure Prophylaxis Adherence, Thai Men Who Have Sex With Men, and Transgender Women, 2012-2013. J Acquir Immune Defic Syndr 2019; 82:e18-e26. [PMID: 31490342 PMCID: PMC6742570 DOI: 10.1097/qai.0000000000002131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/26/2022]
Abstract
BACKGROUND We identified correlates of sex-related pre-exposure prophylaxis (PrEP) adherence in HPTN067/ADAPT, a phase 2, open-label feasibility study of daily and nondaily regimens of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based PrEP, among Thai men who have sex with men (MSM), and transgender women (TGW), Bangkok. METHODS Participants were randomly assigned to one of three self-administered dosing regimens for 24 weeks: daily, time-driven, or event-driven. Demographic and behavioral information was obtained at screening. Pill-container opening was recorded with electronic dose monitoring, and self-reported information on PrEP use, sex events, and substance use was obtained during weekly interviews to confirm dose data. Sex-related PrEP adherence was calculated as the proportion of sex events covered by PrEP use (at least one tablet taken within 4 days before sex and at least one tablet taken within 24 hours after sex) to total sex events. We used multivariate modeling with sex event as the unit of analysis to evaluate correlates associated with sex-related PrEP adherence. RESULTS Among 178 MSM and TGW, sex-related PrEP adherence was similar in the daily and time-driven arms (P = 0.79), both significantly greater than the event-driven arm (P = 0.02 compared to daily). Sex-related PrEP adherence by those reporting stimulant use (74.2%) was similar to those reporting other nonalcohol drug use (76.3%, P = 0.80), but lower than those reporting no substance use (84.6%, P = 0.04). In a multivariable model, randomization to the event-driven arm, a higher prestudy number of reported sex events, and use of stimulant drugs were associated with significantly lower sex-related PrEP adherence. CONCLUSION Adherence was influenced by treatment schedule and adversely affected by nonalcoholic substance use. Regardless of these factors, Thai MSM and TGW maintained high adherence levels to oral PrEP dosing regimens and coverage of sexual exposures.
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Affiliation(s)
- Timothy H. Holtz
- Thailand Ministry of Public Health -U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, United States
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Marcel E. Curlin
- Thailand Ministry of Public Health -U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Oregon Health Sciences University, Portland, United States
| | - Anchalee Varangrat
- Thailand Ministry of Public Health -U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Philip A. Mock
- Thailand Ministry of Public Health -U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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18
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Velloza J, Bacchetti P, Hendrix CW, Murnane P, Hughes JP, Li M, E. Curlin M, Holtz TH, Mannheimer S, Marzinke MA, Amico KR, Liu A, Piwowar-Manning E, Eshleman SH, Dye BJ, Gandhi M, Grant RM. Short- and Long-Term Pharmacologic Measures of HIV Pre-exposure Prophylaxis Use Among High-Risk Men Who Have Sex With Men in HPTN 067/ADAPT. J Acquir Immune Defic Syndr 2019; 82:149-158. [PMID: 31335588 PMCID: PMC6749964 DOI: 10.1097/qai.0000000000002128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of oral emtricitabine (FTC)/tenofovir (TFV) disoproxil fumarate-based HIV pre-exposure prophylaxis (PrEP) depends on adherence. Pharmacologic measures help interpret patterns and predictors of PrEP adherence. SETTING We analyzed data from the subsample of men who have sex with men enrolled in HPTN 067/ADAPT in Bangkok, Thailand, and Harlem, NY, U.S. METHODS After a 5-week directly observed therapy period, participants were randomized to daily, time-driven, or event-driven PrEP. Follow-up occurred at weeks 4, 12, and 24 after randomization. Plasma and hair FTC/TFV levels indicated short- and long-term PrEP use, respectively. Electronic pill bottle data (Wisepill) were collected weekly. Pearson correlation coefficients between PrEP use measures were calculated; linear mixed models assessed predictors of plasma and hair drug concentrations. RESULTS Among 350 participants (median age: 31 years, interquartile range: 25-38), 49.7% were from Harlem, half had less than college education, and 21% reported heavy alcohol use. In multivariable models, being enrolled in Harlem, being in non-daily arms, and having less than college education were associated with lower hair FTC/TFV concentrations; heavy alcohol use was associated with higher concentrations. Similar results were found for plasma concentrations by site and arm, but older age and greater number of sex partners were associated with higher concentrations. Hair and plasma FTC/TFV concentrations were moderately correlated with Wisepill data (r ≥ 0.29) across visits. CONCLUSIONS In HPTN067, plasma, hair, and Wisepill data correlated with one another and served as complementary adherence measures. Site, arm, education, age, alcohol, and sexual behavior influenced patterns of adherence.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA
| | - Peter Bacchetti
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | | | - Pamela Murnane
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | - James P. Hughes
- Department of Global Health, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marcel E. Curlin
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
- Division of Infectious Disease, Oregon Health & Science University, Portland, OR
| | - Timothy H. Holtz
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
| | | | | | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Albert Liu
- San Francisco Department of Public Health, San Francisco, CA
| | | | | | | | - Monica Gandhi
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | - Robert M. Grant
- School of Medicine, University of California at San Francisco, San Francisco, CA
- Gladstone Institute of Virology and Immunology, University of California at San Francisco, San Francisco, CA
| | - HPTN 067/ADAPT Study Team
- Department of Global Health, University of Washington, Seattle, WA
- School of Medicine, University of California at San Francisco, San Francisco, CA
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Fred Hutchinson Cancer Research Center, Seattle, WA
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
- Division of Infectious Disease, Oregon Health & Science University, Portland, OR
- Columbia University, New York, NY
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
- San Francisco Department of Public Health, San Francisco, CA
- FHI 360, Durham, NC; and
- Gladstone Institute of Virology and Immunology, University of California at San Francisco, San Francisco, CA
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Spinelli MA, Glidden DV, Anderson PL, Gandhi M, McMahan VM, Defechereux P, Schechter M, Veloso VG, Chariyalertsak S, Guanira JV, Bekker LG, Buchbinder SP, Grant RM. Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project. AIDS Res Hum Retroviruses 2019; 35:788-793. [PMID: 31119944 PMCID: PMC6735322 DOI: 10.1089/aid.2018.0297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/08/2023] Open
Abstract
Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, open-label PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cut-offs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.
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Affiliation(s)
- Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California
| | - Vanessa M. McMahan
- Department of Health Services, University of Washington, Seattle, Washington
| | - Patricia Defechereux
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Mauro Schechter
- Department of Preventive Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valdiléa G. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences and Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Susan P. Buchbinder
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Robert M. Grant
- Department of Medicine, University of California, San Francisco, San Francisco, California
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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.
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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
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21
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Hojilla JC, Vlahov D, Glidden DV, Amico KR, Mehrotra M, Hance R, Grant RM, Carrico AW. Skating on thin ice: stimulant use and sub-optimal adherence to HIV pre-exposure prophylaxis. J Int AIDS Soc 2019; 21:e25103. [PMID: 29577616 PMCID: PMC5867332 DOI: 10.1002/jia2.25103] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/08/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Stimulant and heavy alcohol use are prevalent and associated with elevated risk for HIV seroconversion among men who have sex with men (MSM) and transgender women. In addition, each can pose difficulties for antiretroviral adherence among people living with HIV. Scant research has examined the associations of stimulant and heavy alcohol use with adherence to daily oral pre‐exposure prophylaxis (PrEP) among MSM and transgender women. To address this gap in the literature, we evaluated the hypothesis that stimulant use and binge drinking are prospectively associated with sub‐optimal PrEP adherence. Methods We analysed data from participants in a nested case‐cohort in the iPrEx open label extension. Stimulant use (i.e. powder cocaine, crack‐cocaine, cocaine paste, methamphetamine, cathinone) and binge drinking (i.e. ≥5 drinks in a single day) in the last 30 days were assessed. Baseline urine was tested for stimulants using immunoassays to reduce misclassification. Sub‐optimal adherence was defined as tenofovir drug concentrations in dried blood spots less than 700 fmol per punch, indicative of less than four doses per week. We tested the prospective association of stimulant use and binge drinking with sub‐optimal adherence at the 4‐week follow‐up visit. Results and Discussion Data from 330 participants were analysed. The majority of the participants were MSM (89%) with a median age at baseline of 29 years (interquartile range 24 to 39). Approximately 16% (52/330) used stimulants and 22% (72/330) reported binge drinking in the last 30 days. Stimulant users had fivefold greater odds of sub‐optimal PrEP adherence compared to non‐users in adjusted analysis (adjusted odds ratio [aOR] 5.04; [95% CI 1.35 to 18.78]). Self‐reported binge drinking was not significantly associated with sub‐optimal adherence after adjusting for stimulant use and baseline confounders (aOR 1.16 [0.49 to 2.73]). Depressive symptoms, being transgender, and number of sex partners were also not significantly associated with sub‐optimal PrEP adherence (p > 0.05). Conclusions Stimulant use is a risk factor for sub‐optimal PrEP adherence in the month following PrEP initiation. Comprehensive prevention approaches that reduce stimulant use may optimize PrEP adherence. Creating adherence plans that specifically address PrEP dosing in the context of ongoing stimulant use should also be considered.
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Affiliation(s)
| | | | | | | | - Megha Mehrotra
- University of CaliforniaSan FranciscoSan FranciscoCAUSA
- J. David Gladstone InstitutesSan FranciscoCAUSA
| | | | - Robert M Grant
- University of CaliforniaSan FranciscoSan FranciscoCAUSA
- J. David Gladstone InstitutesSan FranciscoCAUSA
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22
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Chemnasiri T, Varangrat A, Amico KR, Chitwarakorn A, Dye BJ, Grant RM, Holtz TH. Facilitators and barriers affecting PrEP adherence among Thai men who have sex with men (MSM) in the HPTN 067/ADAPT Study. AIDS Care 2019; 32:249-254. [PMID: 31159584 DOI: 10.1080/09540121.2019.1623374] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The HPTN 067/ADAPT Study evaluated the feasibility, acceptability, patterns of adherence and coverage for three randomly assigned oral FTC/TDF pre-exposure prophylaxis (PrEP) dosing regimens to prevent HIV infection. Using qualitative methods, we explored facilitators and barriers among a subset of men who have sex with men (MSM) participants in Bangkok, Thailand. Between August 2013 and March 2014, 32 HPTN 067/ADAPT participants joined in 6 focus group discussions, and 6 attended key informant interviews. Facilitators of PrEP adherence included use of strategies to have PrEP available when needed, simplicity in regimen requirements with recognition that more complex regimens may take some time to master, ability to plan for sex, receipt of social and technology support, ability to use a PrEP regimen that best matches to one's own patterns of sex, and experiences with PrEP as a part of health and well-being. Challenges to PrEP adherence included perceptions of no or low HIV risk, difficulties following regimens when intoxicated, concerns about side effects, experience of HIV stigma, and affordability of PrEP outside of study context influencing uptake and use in the community. Preferences for regimens varied, suggesting that multiple PrEP effective regimen options should be available to fit those with different needs.
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Affiliation(s)
- Tareerat Chemnasiri
- Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Varangrat
- Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robert M Grant
- Gladstone Institutes, University of California, San Francisco, CA, 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, Centers for Disease Control and Prevention, Atlanta, GA, USA
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23
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Mannheimer S, Hirsch-Moverman Y, Franks J, Loquere A, Hughes JP, Li M, Amico KR, Grant RM. Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067. J Acquir Immune Defic Syndr 2019; 80:551-558. [PMID: 30865051 PMCID: PMC6417801 DOI: 10.1097/qai.0000000000001965] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP). METHODS Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios. RESULTS Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting "I forgot" as an adherence barrier. CONCLUSIONS This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.
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Affiliation(s)
- Sharon Mannheimer
- Department of Epidemiology, ICAP, Mailman School of Public Health, Columbia University, New York City Health + Hospitals/Harlem, New York, NY
| | | | - Julie Franks
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | - Avelino Loquere
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; and
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24
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Spinelli MA, Glidden DV, Rodrigues WC, Wang G, Vincent M, Okochi H, Kuncze K, Mehrotra M, Defechereux P, Buchbinder SP, Grant RM, Gandhi M. Low tenofovir level in urine by a novel immunoassay is associated with seroconversion in a preexposure prophylaxis demonstration project. AIDS 2019; 33:867-872. [PMID: 30649051 PMCID: PMC6375797 DOI: 10.1097/qad.0000000000002135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/25/2022]
Abstract
OBJECTIVE We examined the relationship between urine tenofovir (TFV) levels measured with a novel immunoassay, which permits point-of-care testing, with HIV seroconversion and objective adherence metrics in a large preexposure prophylaxis (PrEP) demonstration project. DESIGN Secondary analysis of stored specimens from an open-label PrEP cohort study. METHODS We examined the association between undetectable urine TFV levels and HIV seroconversion in iPrEx open-label extension using generalized estimating equations. We examined rank correlations between levels of TFV and emtricitabine in urine, dried blood spots (DBS), and hair and determined the sensitivity and specificity of undetectable urine TFV for predicting dosing cut-offs in DBS. RESULTS The median urinary TFV level was 15 000 ng/ml in those who remained HIV-negative (n = 105; interquartile range: 1000-45 000); 5500 in those who eventually seroconverted (n = 11; interquartile range: 1000-12 500); and all were undetectable at seroconversion (n = 9; P < 0.001). Decreasing strata of urine TFV levels were associated with future HIV seroconversion (P = 0.03). An undetectable urine TFV was 100% sensitive and 81% specific when compared with an undetectable DBS TFV-diphosphate level and 69% sensitive, but 94% specific when compared with low adherence by DBS (<2 doses/week). CONCLUSION Urine TFV detection by a novel antibody-based assay was associated with protection from HIV acquisition among individuals on PrEP. Urine TFV levels were correlated with hair and DBS levels and undetectable urine TFV was 100% sensitive in detecting nonadherence. By implementing the immunoassay into a point-of-care strip test, PrEP nonadherence could be detected in real-time, allowing rapid intervention.
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Affiliation(s)
| | - David V Glidden
- Department of Epidemiology and Biostastistics, University of California, San Francisco, San Francisco
| | | | - Guohong Wang
- Alere Rapid Diagnostics/Abbott Rapid Diagnostics Division, Pomona
| | - Michael Vincent
- Alere Rapid Diagnostics/Abbott Rapid Diagnostics Division, Pomona
| | | | - Karen Kuncze
- Department of Bioengineering and Therapeutic Sciences
| | - Megha Mehrotra
- Department of Epidemiology and Biostastistics, University of California, San Francisco, San Francisco
| | | | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, USA
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco
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25
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Truong HHM, Pipkin S, Grant RM, Liegler T, O'Keefe KJ, Scheer S. Increased uptake of early initiation of antiretroviral therapy and baseline drug resistance testing in San Francisco between 2001 and 2015. PLoS One 2019; 14:e0213167. [PMID: 30870438 PMCID: PMC6417784 DOI: 10.1371/journal.pone.0213167] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Early initiation of antiretroviral therapy (eiART) can improve clinical outcomes for persons with HIV and reduce onward transmission risk. Baseline drug resistance testing (bDRT) can inform regimen selection upon subsequent treatment initiation. We examined the uptake of eiART and bDRT within 3 months and 30 days of HIV diagnosis. Methods We analyzed a population-based sample from the San Francisco Department of Public Health HIV/AIDS Case Registry of newly-diagnosed HIV/non-AIDS individuals between 2001 and 2015 who received care at publicly-funded facilities (N = 3,124). Results Uptake of eiART within 3 months of diagnosis increased significantly from 2001 to 2015 (p<0.001), peaking at 74% in 2015. bDRT uptake also increased significantly (p<0.001), peaking at 55% in 2012. eiART uptake was observed to be significantly associated with gender, age, race/ethnicity and transmission risk. There were no significant differences observed in demographic and risk characteristics of persons receiving bDRT in the more recent years. Of 990 persons diagnosed between 2010 and 2015, eiART uptake within 30 days of diagnosis increased from 13% to 38% (p<0.001); bDRT uptake increased from 35% to 39% but the change was not significant (p = 0.141). Conclusions Observed increases in eiART and bDRT uptake from 2010 to 2015 may reflect the adoption of treatment as prevention and a local public health policy statement in 2010 recommending treatment initiation at time of diagnosis irrespective of CD4 count. Concerns about stigma may underlie disparities in eiART, however such concerns would not bear as directly on a provider-initiated laboratory test like bDRT.
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Affiliation(s)
- Hong-Ha M Truong
- Department of Medicine, University of California, San Francisco, United States of America.,Gladstone Institute of Virology and Immunology, San Francisco, United States of America
| | - Sharon Pipkin
- Department of Public Health, San Francisco, United States of America
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, United States of America.,Gladstone Institute of Virology and Immunology, San Francisco, United States of America
| | - Teri Liegler
- Department of Medicine, University of California, San Francisco, United States of America
| | - Kara J O'Keefe
- Department of Public Health, San Francisco, United States of America
| | - Susan Scheer
- Department of Public Health, San Francisco, United States of America
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26
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Cohen SE, Sachdev D, Lee SA, Scheer S, Bacon O, Chen MJ, Okochi H, Anderson PL, Kearney MF, Coffey S, Scott H, Grant RM, Havlir D, Gandhi M. Acquisition of tenofovir-susceptible, emtricitabine-resistant HIV despite high adherence to daily pre-exposure prophylaxis: a case report. Lancet HIV 2018; 6:S2352-3018(18)30288-1. [PMID: 30503324 PMCID: PMC6541554 DOI: 10.1016/s2352-3018(18)30288-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 04/08/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate is highly protective against HIV infection. We report a case of tenofovir-susceptible, emtricitabine-resistant HIV acquisition despite high adherence to daily PrEP. METHODS Adherence to PrEP was assessed by measuring concentrations of emtricitabine and tenofovir disoproxil fumarate or their metabolites in plasma, dried blood spots, and hair. After seroconversion, genotypic and phenotypic resistance of the acquired virus was determined by standard clinical tests and by single-genome sequencing of proviral genomes. HIV partner services identified the likely transmission partner. FINDINGS A 21-year-old Latino man tested positive for HIV infection 13 months after PrEP initiation. He had a negative HIV antibody test, but detectable HIV RNA with 559 copies per mL. He reported good adherence to daily PrEP. He was linked to care and immediately started antiretroviral therapy, at which point his RNA was 1544 copies per mL and his HIV antibody test was positive. The HIV genotype revealed Met184Val, Leu74Val, Leu100Ile, and Lys103Asn mutations in reverse transcriptase, and the phenotype showed susceptibility to tenofovir disoproxil fumarate and resistance to emtricitabine. Segmental hair analysis of tenofovir disoproxil fumarate concentrations measured in 1 cm segments of hair from the scalp indicated consistently high adherence to PrEP in each of the 6 months before HIV diagnosis (0·0672-0·0889 ng/mg). Concentrations of tenofovir diphosphate (1012 fmol per punch) and emtricitabine triphosphate (0·266 fmol per punch) in a dried blood spot indicated high adherence over the preceding 6 weeks. Concentrations of emtricitabine (870·5 ng/mL) and tenofovir disoproxil fumarate (188·2 ng/mL) measured in plasma 3 months before HIV seroconversion confirmed adherence in the days preceding that visit. The likely transmission partner was not engaged in HIV primary care and had a similar viral genotype. INTERPRETATION Acquisition of HIV virus that is susceptible to tenofovir disoproxil fumarate, but resistant to emtricitabine can occur despite high adherence to PrEP. Quarterly screening for HIV and sexually transmitted diseases facilitates early diagnosis in people on PrEP; when combined with prompt linkage to care and partner services this can prevent onward transmission of HIV. FUNDING US National Institutes of Health.
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Affiliation(s)
- Stephanie E Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA.
| | - Darpun Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sulggi A Lee
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Oliver Bacon
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Miao-Jung Chen
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Hideaki Okochi
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Peter L Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Mary F Kearney
- HIV Dynamics and Replication Program, National Cancer Institute at Frederick, Frederick, MD, USA
| | - Susa Coffey
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Grant
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
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27
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Murray MI, Markowitz M, Frank I, Grant RM, Mayer KH, Hudson KJ, Stancil BS, Ford SL, Patel P, Rinehart AR, Spreen WR, Margolis DA. Satisfaction and acceptability of cabotegravir long-acting injectable suspension for prevention of HIV: Patient perspectives from the ECLAIR trial. HIV Clin Trials 2018; 19:129-138. [PMID: 30445896 DOI: 10.1080/15284336.2018.1511346] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cabotegravir (GSK1265744) is an integrase strand transfer inhibitor in development as a long-acting (LA) intramuscular injectable suspension for HIV-1 pre-exposure prophylaxis (PrEP). OBJECTIVE We report participant outcomes from the phase IIa ECLAIR study related to tolerability, acceptability, and satisfaction of cabotegravir LA. METHODS The ECLAIR study (ClinicalTrials.gov identifier, NCT02076178) was a randomized, placebo-controlled study in healthy men not at high risk of acquiring HIV-1. Participants were randomized (5:1) to once-daily oral cabotegravir 30 mg or placebo tablets for 4 weeks, followed by gluteal intramuscular injections of cabotegravir LA 800 mg or saline placebo every 12 weeks. The primary objective was to evaluate the safety of cabotegravir LA over three injection cycles (to Week 41). Secondary objectives assessed the tolerability, satisfaction, and acceptability of cabotegravir LA. RESULTS Among 115 participants who received injections in the cabotegravir (n = 94) and placebo (n = 21) groups, 93% (n = 87) and 95% (n = 20) completed the injection phase, respectively. Injection intolerability led to withdrawal in 4 participants (4%) receiving cabotegravir LA. The most frequently reported Grade ≥2 adverse event was injection-site pain. Most participants (74% [n = 67]) receiving consecutive injections favored cabotegravir LA vs oral cabotegravir. Most participants were satisfied with cabotegravir LA (75% [n = 64]), were willing to continue (79% [n = 68]), and would recommend (87% [n = 75]) the therapy. CONCLUSIONS While Grade ≥2 injection-site pain was common, most participants reported overall satisfaction with and preference for cabotegravir LA, with few discontinuations due to injection intolerance. These findings support investigation of cabotegravir LA as an alternative to daily oral PrEP regimens.
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Affiliation(s)
| | - Martin Markowitz
- b The Aaron Diamond AIDS Research Center, an affiliate of the Rockefeller University , New York , NY , USA
| | - Ian Frank
- c Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Robert M Grant
- d Institute of Virology and Immunology, Gladstone Institutes , San Francisco , CA , USA.,e Department of Medicine , University of California , San Francisco , CA , USA
| | - Kenneth H Mayer
- f The Fenway Institute, Fenway Health , Boston , MA , USA.,g Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | | | | | - Susan L Ford
- j GlaxoSmithKline , Research Triangle Park , NC , USA
| | - Parul Patel
- h ViiV Healthcare , Research Triangle Park , NC , USA
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28
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Stekler JD, Violette LR, Niemann L, McMahan VM, Katz DA, Baeten JM, Grant RM, Delaney KP. Repeated False-Positive HIV Test Results in a Patient Taking HIV Pre-Exposure Prophylaxis. Open Forum Infect Dis 2018; 5:ofy197. [PMID: 30276221 PMCID: PMC6157305 DOI: 10.1093/ofid/ofy197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/18/2018] [Indexed: 11/23/2022] Open
Abstract
Regular HIV testing is required to ensure the safety of HIV pre-exposure prophylaxis (PrEP). We describe and discuss a series of false-positive HIV test results from an individual receiving PrEP. The expansion of PrEP will likely result in greater numbers of false-positive test results that may pose challenges for interpretation.
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Affiliation(s)
- Joanne D Stekler
- Departments of 1Medicine, University of Washington, Seattle, Washington.,Epidemiology, University of Washington, Seattle, Washington.,Global Health, University of Washington, Seattle, Washington
| | - Lauren R Violette
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - Lisa Niemann
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - Vanessa M McMahan
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - David A Katz
- Departments of 1Medicine, University of Washington, Seattle, Washington.,HIV/STD Program, Public Health - Seattle & King County, Washington
| | - Jared M Baeten
- Departments of 1Medicine, University of Washington, Seattle, Washington.,Epidemiology, University of Washington, Seattle, Washington.,Global Health, University of Washington, Seattle, Washington
| | | | - Kevin P Delaney
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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29
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Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
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Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Glidden DV, Mulligan K, McMahan V, Anderson PL, Guanira J, Chariyalertsak S, Buchbinder SP, Bekker LG, Schechter M, Grinsztejn B, Grant RM. Metabolic Effects of Preexposure Prophylaxis With Coformulated Tenofovir Disoproxil Fumarate and Emtricitabine. Clin Infect Dis 2018; 67:411-419. [PMID: 29415175 PMCID: PMC6051460 DOI: 10.1093/cid/ciy083] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Received: 12/06/2017] [Accepted: 02/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background Antiretroviral drugs have been associated with changes in lipids, fat mass and dat distribution. Tenofovir disoproxil fumarate (TDF) has been shown to have a more favorable metabolic profile than other drugs in its class. However, the metabolic effects of TDF in preexposure prophylaxis (PrEP) are unknown. Methods We evaluated the effects of TDF/emtricitabine (FTC) on lipids and body composition in a blinded, placebo-controlled PrEP trial. Participants enrolled in a metabolic subcohort (N = 251, TDF/FTC; N = 247, placebo) consented to fasting lipid panels, dual-energy X-ray absorptiometry scans for body composition, and pharmacologic testing of drug metabolites at baseline and every 24 weeks thereafter. Results Lean body mass was stable and unaffected by TDF/FTC. Body weight increased in both groups but was lower on TDF/FTC through week 72. This difference was explained by lower fat accumulation on TDF/FTC. The net median percent difference (standard error, P value) for TDF/FTC vs placebo at week 24 was -0.8% (0.4%, P = .02), +0.3% (0.4%, P = .46), and -3.8% (1.4%, P = .009) for total, lean, and fat mass, respectively. There was no apparent differential regional fat accumulation on TDF/FTC. Decreases in cholesterol, but not triglycerides, were seen in TDF/FTC participants, with detectable drug levels compared to placebo. Conclusions TDF/FTC for PrEP showed cholesterol reductions and appeared to transiently suppress the accumulation of weight and body fat compared to placebo. There was no evidence of altered fat distribution or lipodystrophy during daily oral TDF/FTC PrEP. Clinical Trials Registration NCT00458393.
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Affiliation(s)
| | | | | | | | | | | | - Susan P Buchbinder
- University of California, San Francisco
- Bridge HIV, San Francisco Department of Public Health, California
| | - Linda-Gail Bekker
- University of California, San Francisco
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Mauro Schechter
- Projeto Praça Onze, Hospital Escola São Francisco de Assis and Universidade Federal do Rio de Janeiro
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Fiocruz, Rio de Janeiro, Brazil
| | - Robert M Grant
- Gladstone Institute of Virology, California
- San Francisco AIDS Foundation, California
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31
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Davis AK, Barsuglia JP, Lancelotta R, Grant RM, Renn E. The epidemiology of 5-methoxy- N, N-dimethyltryptamine (5-MeO-DMT) use: Benefits, consequences, patterns of use, subjective effects, and reasons for consumption. J Psychopharmacol 2018; 32:779-792. [PMID: 29708042 PMCID: PMC6248886 DOI: 10.1177/0269881118769063] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIM 5-Methoxy- N,N-dimethyltryptamine (5-MeO-DMT) is a psychoactive compound found in several plants and in high concentrations in Bufo alvarius toad venom. Synthetic, toad, and plant-sourced 5-MeO-DMT are used for spiritual and recreational purposes and may have psychotherapeutic effects. However, the use of 5-MeO-DMT is not well understood. Therefore, we examined patterns of use, motivations for consumption, subjective effects, and potential benefits and consequences associated with 5-MeO-DMT use. METHODS Using internet-based advertisements, 515 respondents ( Mage=35.4. SD=11.7; male=79%; White/Caucasian=86%; United States resident=42%) completed a web-based survey. RESULTS Most respondents consumed 5-MeO-DMT infrequently (<once/year), for spiritual exploration, and had used less than four times in their lifetime. The majority (average of 90%) reported moderate-to-strong mystical-type experiences ( Mintensity=3.64, SD=1.11; range 0-5; e.g., ineffability, timelessness, awe/amazement, experience of pure being/awareness), and relatively fewer (average of 37%) experienced very slight challenging experiences ( Mintensity=0.95, SD=0.91; range 0-5; e.g., anxiousness, fear). Less than half (39%) reported repeated consumption during the same session, and very few reported drug craving/desire (8%), or legal (1%), medical (1%), or psychiatric (1%) problems related to use. Furthermore, of those who reported being diagnosed with psychiatric disorders, the majority reported improvements in symptoms following 5-MeO-DMT use, including improvements related to post-traumatic stress disorder (79%), depression (77%), anxiety (69%), and alcoholism (66%) or drug use disorder (60%). CONCLUSION Findings suggest that 5-MeO-DMT is used infrequently, predominantly for spiritual exploration, has low potential for addiction, and might have psychotherapeutic effects. Future research should examine the safety and pharmacokinetics of 5-MeO-DMT administration in humans using rigorous experimental designs.
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Affiliation(s)
- Alan K. Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | | | - Rafael Lancelotta
- School of Counseling, Leadership, Advocacy, and Design, University of Wyoming, 1000 E. University Ave. Dept. 3374 Laramie, WY 82071 USA
| | - Robert M. Grant
- Department of Medicine, University of California, San Francisco, 1001 Potrero St, Building 100, Room 603, San Francisco, CA 94110 USA
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32
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Truong HHM, Fatch R, Grant RM, Mathur M, Kumta S, Jerajani H, Kellogg TA, Lindan CP. Characterization of HIV Recent Infection Among High-Risk Men at Public STI Clinics in Mumbai. AIDS Behav 2018; 22:70-75. [PMID: 29453551 DOI: 10.1007/s10461-018-2052-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/24/2022]
Abstract
We examined associations with HIV recent infection and estimated transmitted drug resistance (TDR) prevalence among 3345 men at sexually transmitted infection clinics in Mumbai (2002-2005). HIV seroincidence was 7.92% by the BED-CEIA and was higher at a clinic located near brothels (12.39%) than at a hospital-based clinic (3.94%). HIV recent infection was associated with a lifetime history of female sex worker (FSW) partners, HSV-2, genital warts, and gonorrhea. TDR prevalence among recent infection cases was 5.7%. HIV testing services near sex venues may enhance case detection among high-risk men who represent a bridging population between FSWs and the men's other sexual partners.
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Affiliation(s)
- Hong-Ha M Truong
- University of California, San Francisco, San Francisco, CA, USA.
- Gladstone Institute of Virology and Immunology, San Francisco, CA, USA.
| | - Robin Fatch
- University of California, San Francisco, San Francisco, CA, USA
| | - Robert M Grant
- University of California, San Francisco, San Francisco, CA, USA
- Gladstone Institute of Virology and Immunology, San Francisco, CA, USA
| | - Meenakshi Mathur
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Sameer Kumta
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Hemangi Jerajani
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Ryan KE, Mak A, Stoove M, Price B, Fairley CK, Ruth S, Lal L, Asselin J, El-Hayek C, Nguyen L, Batrouney C, Wilson D, Lockwood J, Murphy D, Cornelisse VJ, Roth N, Willcox J, Chang CC, Armishaw J, Tee BK, Penn M, Forgan-Smith G, Williams C, Montgomery J, Byron K, Coelho A, Allen B, Wiggins J, Kelsall J, Vujovic O, West M, Pierce AB, Gallant D, Bell C, de Wit JBF, Hoy JF, Wesselingh SL, Grant RM, Wright EJ. Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study. Front Public Health 2018; 6:151. [PMID: 29896468 PMCID: PMC5987055 DOI: 10.3389/fpubh.2018.00151] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent HIV transmission in people at high risk of HIV acquisition. PrEP is highly efficacious when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate if the provision of PrEP to up to 3800 individuals at risk of HIV in Victoria, Australia reduces HIV incidence locally by 25% generally and 30% among GBM. Methods: PrEPX is a population level intervention study in Victoria, Australia in which generic PrEP will be delivered to 3800 individuals for up to 36 months. Study eligibility is consistent with the recently updated 2017 Australian PrEP guidelines. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tests and other clinical care as required. Study visits and STI diagnoses will be recorded electronically through the ACCESS surveillance system. At each study visit participants will be invited to complete behavioral surveys that collect demographics and sexual risk data. Diagnosis and behavioral data will be compared between PrEPX participants and other individuals testing within the ACCESS surveillance system. A subset of participants will complete in depth surveys and interviews to collect attitudes, beliefs and acceptability data. Participating clinics will provide clinic level data on implementation and management of PrEPX participants. The population level impact on HIV incidence will be assessed using Victorian HIV notification data. Discussion: This study will collect evidence on the real world impact of delivery of PrEP to 3800 individuals at risk of acquiring HIV in Victoria. This study will provide important information for the broader implementation of PrEP planning upon listing of the tenofovir-emtricitabine on the national subsidized list of medicines. The study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12616001215415)
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Affiliation(s)
- Kathleen E Ryan
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Mak
- Alfred Health Pharmacy, Melbourne, VIC, Australia
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Simon Ruth
- Victorian AIDS Council, Melbourne, VIC, Australia
| | - Luxshimi Lal
- The Burnet Institute, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | | | | | - Long Nguyen
- The Burnet Institute, Melbourne, VIC, Australia
| | | | | | | | - Dean Murphy
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, VIC, Australia
| | | | - Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | | | - Ban K Tee
- The Centre Clinic, Melbourne, VIC, Australia.,Access Health and Community Richmond, Melbourne, VIC, Australia
| | - Matthew Penn
- PRONTO! Community Health Centre, Melbourne, VIC, Australia
| | | | | | | | - Kat Byron
- Victorian Aboriginal Community Controlled Health Organisation Inc., Melbourne, VIC, Australia
| | - Alison Coelho
- Centre for Culture, Ethnicity and Health, Melbourne, VIC, Australia
| | - Brent Allen
- Living Positive Victoria, Melbourne, VIC, Australia
| | - Jeremy Wiggins
- Victorian AIDS Council, Melbourne, VIC, Australia.,Peer Advocacy Network for the Sexual Health of Trans Masculinities, Melbourne, VIC, Australia
| | | | - Olga Vujovic
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Michael West
- Sexual Health and Viral Hepatitis Service Department of Health and Human Services, Government of Victoria, Melbourne, VIC, Australia
| | - Anna B Pierce
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Daniel Gallant
- Sexually Transmissible Infection and Blood Borne Virus Section, Communicable Disease Control Branch, Department of Health and Ageing, Government of South Australia, Adelaide, SA, Australia
| | - Charlotte Bell
- Clinic 275, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John B F de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert M Grant
- School of Medicine, University of California San Francisco, Gladstone Institutes, San Francisco, CA, United States
| | - Edwina J Wright
- The Burnet Institute, Melbourne, VIC, Australia.,The Centre Clinic, Melbourne, VIC, Australia.,Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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Franks J, Hirsch-Moverman Y, Loquere AS, Amico KR, Grant RM, Dye BJ, Rivera Y, Gamboa R, Mannheimer SB. Sex, PrEP, and Stigma: Experiences with HIV Pre-exposure Prophylaxis Among New York City MSM Participating in the HPTN 067/ADAPT Study. AIDS Behav 2018; 22:1139-1149. [PMID: 29143163 PMCID: PMC5878834 DOI: 10.1007/s10461-017-1964-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The HPTN 067/Alternative Dosing to Augment Pre-Exposure Prophylaxis Pill Taking (ADAPT) study evaluated daily and non-daily dosing schedules for oral pre-exposure prophylaxis (PrEP) to prevent HIV. A qualitative sub-study including focus groups and in-depth interviews was conducted among men who have sex with men participating in New York City to understand their experience with PrEP and study dosing schedules. The 37 sub-study participants were 68% black, 11% white, and 8% Asian; 27% were of Hispanic/Latino ethnicity. Mean age was 34 years. Themes resulting from qualitative analysis include: PrEP is a significant advance for HIV prevention; non-daily dosing of PrEP is congruent with HIV risk; and pervasive stigma connected to HIV and risk behavior is a barrier to PrEP adherence, especially for non-daily dosing schedules. The findings underscore how PrEP intersects with other HIV prevention practices and highlight the need to understand and address multidimensional stigma related to PrEP use.
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Affiliation(s)
- Julie Franks
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA.
| | - Yael Hirsch-Moverman
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Avelino S Loquere
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Robert M Grant
- Gladstone Institutes, University of California, San Francisco, San Francisco, CA, USA
| | | | - Yan Rivera
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - Robert Gamboa
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - Sharon B Mannheimer
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Harlem Hospital Center, New York, NY, USA
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35
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Fuchs JD, Stojanovski K, Vittinghoff E, McMahan VM, Hosek SG, Amico KR, Kouyate A, Gilmore HJ, Buchbinder SP, Lester RT, Grant RM, Liu AY. A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis. AIDS Patient Care STDS 2018; 32:104-111. [PMID: 29565183 PMCID: PMC5865612 DOI: 10.1089/apc.2017.0255] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Preexposure prophylaxis is a highly protective HIV prevention strategy, yet nonadherence can significantly reduce its effectiveness. We conducted a mixed methods evaluation of a mobile health intervention (iText) that utilized weekly bidirectional text or e-mail support messages to encourage preexposure prophylaxis (PrEP) adherence among participants in the multi-site iPrEx open-label extension study. A convenience sample of PrEP users from the San Francisco and Chicago sites participated in a 12-week pilot study. Fifty-six men who have sex with men were enrolled; a quarter of them were less than 30 years of age, 13% were black/African American, 11% were Latino, and most (88%) completed some college. Two-thirds opted for text message delivery. Of the 667 messages sent, only 1 individual requested support; initial nonresponse was observed in 22% and was higher among e-mail compared to text message recipients. Poststudy, a majority of participants would recommend the intervention to others, especially during PrEP initiation. Moreover, younger participants and men of color were more likely to report that they would use the iText strategy if it were available to them. Several participants commented that while they were aware that the messages were automated, they felt supported and encouraged that “someone was always there.” Study staff reported that the intervention is feasible to administer and can be incorporated readily into clinic flow. A pre–post intervention regression discontinuity analysis using clinic-based pill counts showed a 50% reduction in missed doses [95% confidence interval (CI) 16–71; p = 0.008] and 77% (95% CI 33–92; p = 0.007) when comparing pill counts at quarterly visits just before and after iText enrollment. A mobile health intervention using weekly bidirectional messaging was highly acceptable and demonstrated promising effects on PrEP adherence warranting further evaluation for efficacy in a randomized controlled trial.
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Affiliation(s)
- Jonathan D. Fuchs
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | | | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, California
| | | | | | - K. Rivet Amico
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Aminta Kouyate
- San Francisco Department of Public Health, San Francisco, California
| | | | - Susan P. Buchbinder
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | | | - Robert M. Grant
- University of California, San Francisco, San Francisco, California
- Gladstone Institute of Virology, San Francisco, California
| | - Albert Y. Liu
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
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Hojilla JC, Mehrotra M, Truong HHM, Glidden DV, Amico KR, McMahan V, Vlahov D, Chariyalertsak S, Guanira JV, Grant RM, For The iPrEx Study Team. HIV sero disclosure among men who have sex with men and transgender women on HIV pre-exposure prophylaxis. AIDS Care 2017; 30:466-472. [PMID: 29082776 DOI: 10.1080/09540121.2017.1394437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV pre-exposure prophyalxis (PrEP) might lead individuals to view serodisclosure as unnecessary. We examined the prevalence of non-disclosure and lack of knowledge of partner status in a global cohort of men who have sex with men (MSM) and transgender women (TW) enrolled in the iPrEx Open Label Extension (OLE). We calculated prevalence ratios by fitting a logistic model and estimating predicted probabilities using marginal standardization. Prevalence of non-disclosure and lack of knowledge of partner status were highest in Thailand (73% and 74%, respectively) and lowest in the USA (23% and 37%, respectively). In adjusted analyses, PrEP use was not significantly associated with non-disclosure or lack of knowledge of partner status (p-values>0.05). We found that relationship characteristics were significantly associated with both outcomes. Non-disclosure was higher among casual (adjusted prevalence ratio [aPR] 1.54, [95% confidence interval 1.24-1.84]) and transactional sex partners (aPR 2.03, [1.44-2.62]), and among partners whom participants have known only minutes or hours before their first sexual encounter (aPR 1.62, [1.33-1.92]). Similarly, participants were less likely to know the HIV status of casual partners (aPR 1.50, [1.30-1.71]), transactional sex partners (aPR 1.62, [1.30-1.95]), and those they have known for only days or weeks (aPR 1.13, [0.99-1.27]) or minutes or hours (aPR 1.27, [1.11-1.42]). Our findings underscore the role of dyadic factors in influencing serodisclosure. Comprehensive risk reduction counseling provided in conjunction with PrEP that address relationship characteristics are needed to help patients navigate discussions around HIV status.
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Affiliation(s)
- J Carlo Hojilla
- a School of Nursing , University of California , San Francisco , CA , USA
| | - Megha Mehrotra
- b Department of Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.,c Gladstone Institute of Virology and Immunology , San Francisco , CA , USA
| | - Hong-Ha M Truong
- d Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | - David V Glidden
- b Department of Epidemiology and Biostatistics , University of California , San Francisco , CA , USA
| | - K Rivet Amico
- e School of Public Health , University of Michigan , Ann Arbor , MI , USA
| | - Vanessa McMahan
- c Gladstone Institute of Virology and Immunology , San Francisco , CA , USA
| | - David Vlahov
- f School of Nursing , Yale University , New Haven , CT
| | | | | | - Robert M Grant
- c Gladstone Institute of Virology and Immunology , San Francisco , CA , USA.,i School of Medicine , University of California , San Francisco
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Markowitz M, Frank I, Grant RM, Mayer KH, Elion R, Goldstein D, Fisher C, Sobieszczyk ME, Gallant JE, Van Tieu H, Weinberg W, Margolis DA, Hudson KJ, Stancil BS, Ford SL, Patel P, Gould E, Rinehart AR, Smith KY, Spreen WR. Safety and tolerability of long-acting cabotegravir injections in HIV-uninfected men (ECLAIR): a multicentre, double-blind, randomised, placebo-controlled, phase 2a trial. Lancet HIV 2017; 4:e331-e340. [PMID: 28546090 DOI: 10.1016/s2352-3018(17)30068-1] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 04/07/2023]
Abstract
BACKGROUND Cabotegravir (GSK1265744) is an HIV-1 integrase strand transfer inhibitor with potent antiviral activity and a long half-life when administered by injection that prevented simian-HIV infection upon repeat intrarectal challenge in male macaques. We aimed to assess the safety, tolerability, and pharmacokinetics of long-acting cabotegravir injections in healthy men not at high risk of HIV-1 infection. METHODS We did this multicentre, double-blind, randomised, placebo-controlled, phase 2a trial at ten sites in the USA. Healthy men (aged 18-65 years) deemed not at high risk of acquiring HIV-1 at screening were randomly assigned (5:1), via computer-generated central randomisation schedules, to receive cabotegravir or placebo. Participants received oral cabotegravir 30 mg tablets or matching placebo once daily during a 4 week oral lead-in phase, followed by a 1 week washout period and, after safety assessment, three intramuscular injections of long-acting cabotegravir 800 mg or saline placebo at 12 week intervals. Study site staff and participants were masked to treatment assignment from enrolment through week 41 (time of the last injection). The primary endpoint was safety and tolerability from the first injection (week 5) to 12 weeks after the last injection. We did analysis in the safety population, defined as all individuals enrolled in the study who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov identifier, NCT02076178. FINDINGS Between March 27, 2014, and Feb 23, 2016, we randomly assigned 127 participants to receive cabotegravir (n=106) or placebo (n=21); 126 (99%) participants comprised the safety population. Most participants were men who have sex with men (MSM; n=106 [83%]) and white (n=71 [56%]). 87 (82%) participants in the cabotegravir group and 20 (95%) participants in the placebo group completed the injection phase. Adverse events (n=7 [7%]) and injection intolerability (n=4 [4%]) were the main reasons for withdrawal in the cabotegravir group. The frequency of grade 2 or higher adverse events was higher in participants in the long-acting cabotegravir group (n=75 [80%]) than in those in the placebo group (n=10 [48%]; p=0·0049), mostly due to injection-site pain (n=55 [59%]). No significant differences were noted in concomitant medications, laboratory abnormalities, electrocardiogram, and vital sign assessments. Geometric mean trough plasma concentrations were 0·302 μg/mL (95% CI 0·237-0·385), 0·331 μg/mL (0·253-0·435), and 0·387 μg/mL (0·296-0·505) for injections one, two, and three, respectively, indicating lower than predicted exposure. The geometric mean apparent terminal phase half-life estimated after the third injection was 40 days. Two (2%) MSM acquired HIV-1 infection, one in the placebo group during the injection phase and one in the cabotegravir group 24 weeks after the final injection when cabotegravir exposure was well below the protein-binding-adjusted 90% inhibitory concentration. INTERPRETATION Despite high incidence of transient, mild-to-moderate injection-site reactions, long-acting cabotegravir was well tolerated with an acceptable safety profile. Pharmacokinetic data suggest that 800 mg administered every 12 weeks is a suboptimal regimen; alternative dosing strategies are being investigated. Our findings support further investigation of long-acting injectable cabotegravir as an alternative to orally administered pre-exposure prophylaxis regimens. FUNDING ViiV Healthcare.
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Affiliation(s)
- Martin Markowitz
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, NY, USA.
| | - Ian Frank
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Susan L Ford
- PAREXEL International, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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Seidman DL, Weber S, Grant RM. Is pericoital or peri-insemination preexposure prophylaxis effective human immunodeficiency prevention for vaginal exposures? Am J Obstet Gynecol 2017; 217:230-231. [PMID: 28479285 DOI: 10.1016/j.ajog.2017.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Koss CA, Bacchetti P, Hillier SL, Livant E, Horng H, Mgodi N, Mirembe BG, Gomez Feliciano K, Horn S, Liu AY, Glidden DV, Grant RM, Benet LZ, Louie A, van der Straten A, Chirenje ZM, Marrazzo JM, Gandhi M, on behalf of the MTN-003 Protocol T. Differences in Cumulative Exposure and Adherence to Tenofovir in the VOICE, iPrEx OLE, and PrEP Demo Studies as Determined via Hair Concentrations. AIDS Res Hum Retroviruses 2017; 33:778-783. [PMID: 28253024 PMCID: PMC5564054 DOI: 10.1089/aid.2016.0202] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevented HIV acquisition among men and women in several trials and is broadly recommended. In the VOICE and FEM-PrEP trials, however, TDF/FTC-based PrEP did not prevent HIV acquisition among women in eastern and southern Africa. Tenofovir was detected in plasma, reflecting exposure and adherence in recent days, in fewer than one-third of participants. Drug concentrations in hair, which represent cumulative exposure and adherence over weeks to months, have never previously been examined among women on PrEP. We compared tenofovir hair concentrations among women assigned to oral TDF/FTC in the VOICE trial to those among men and transgender women enrolled in 2 open-label PrEP studies, the iPrEx open-label extension (OLE) study and the U.S. PrEP Demonstration Project (PrEP Demo). Tenofovir hair concentrations were detectable in 55% of person-visits in VOICE, 75% of person-visits in iPrEx OLE (p = .006), and 98% of person-visits in PrEP Demo (p < .001). Median tenofovir hair concentrations corresponded to an estimated 0.2, 2.9, and 6.0 TDF/FTC doses taken per week in the three studies, respectively. In VOICE, combining tenofovir concentration data from plasma and hair suggested inconsistent, low-level product use. Incorporation of both short- and long-term adherence measures may allow for an improved understanding of patterns of drug-taking among women during global PrEP roll-out.
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Affiliation(s)
- Catherine A. Koss
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sharon L. Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Edward Livant
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Howard Horng
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Nyaradzo Mgodi
- University of Zimbabwe-University of California, San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Brenda G. Mirembe
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Albert Y. Liu
- Department of Medicine, University of California, San Francisco, San Francisco, California
- San Francisco Department of Public Health, Bridge HIV, San Francisco, California
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Robert M. Grant
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Leslie Z. Benet
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Alexander Louie
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Ariane van der Straten
- Department of Medicine, University of California, San Francisco, San Francisco, California
- RTI International, Women's Global Health Imperative, San Francisco, California
| | - Z. Mike Chirenje
- University of Zimbabwe-University of California, San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Jeanne M. Marrazzo
- Department of Medicine, University of Alabama, Birmingham, Birmingham, Alabama
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Koechlin FM, Fonner VA, Dalglish SL, O'Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges-Mameletzis I, Kennedy CE. Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature. AIDS Behav 2017; 21:1325-1335. [PMID: 27900502 PMCID: PMC5378753 DOI: 10.1007/s10461-016-1627-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990-April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.
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Affiliation(s)
- Florence M Koechlin
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
| | - Virginia A Fonner
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Sarah L Dalglish
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Rachel Baggaley
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Robert M Grant
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Michelle Rodolph
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ioannis Hodges-Mameletzis
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Caitlin E Kennedy
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Glidden DV, Mayer K, Grant RM. Response to: A double-edged sword: does highly active antiretroviral therapy contribute to syphilis incidence by impairing immunity to Treponema pallidum? Sex Transm Infect 2017; 93:313. [PMID: 28408646 DOI: 10.1136/sextrans-2017-053212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- David V Glidden
- University of California, San Francisco, San Francisco, California, USA
| | | | - Robert M Grant
- University of California, San Francisco, San Francisco, California, USA
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Gandhi M, Glidden DV, Mayer K, Schechter M, Buchbinder S, Grinsztejn B, Hosek S, Casapia M, Guanira J, Bekker LG, Louie A, Horng H, Benet LZ, Liu A, Grant RM. Association of age, baseline kidney function, and medication exposure with declines in creatinine clearance on pre-exposure prophylaxis: an observational cohort study. Lancet HIV 2016; 3:e521-e528. [PMID: 27658870 PMCID: PMC5085869 DOI: 10.1016/s2352-3018(16)30153-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine for the prevention of HIV infection is rolled out internationally, strategies to maintain effectiveness and to minimise adverse effects merit consideration. In this study, we aimed to assess reductions in renal function and predictors of renal toxicity in a large open-label study of PrEP. METHODS As part of the iPrEx open-label extension (OLE) study, men who have sex with men or transgender women aged 18-70 years who were HIV negative and had participated in three previous PrEP trials from Brazil, Ecuador, Peru, South Africa, Thailand, and the USA were enrolled into an open-label PrEP study. There were no restrictions on current renal function for enrolment into iPrEx OLE, in which participants were given combination tablets of tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) and advised to take one tablet per day. At follow-up sessions every 12 weeks, participants' creatinine clearance on PrEP was estimated and in a subset of participants, hair samples were collected to measure tenofovir and emtricitabine concentrations (a measure of adherence and exposure) via liquid-chromatography-tandem-mass-spectrometry. Reductions in creatinine clearance from baseline were calculated and predictors of decline were identified by use of multivariate models. iPrEx is registered with ClinicalTrials.com, number NCT00458393. FINDINGS Baseline characteristics were similar between all participants in iPrEx-OLE (1224 participants with 7475 person-visits) and those participating in the hair substudy (220 participants with 1114 person-visits). During a median of 72 weeks, the mean decline in creatinine clearance was -2·9% (95% CI -2·4 to -3·4; ptrend<0·0001), but declines were greater for those who started PrEP at older ages: participants aged 40-50 years at baseline had declines of -4·2% (95% CI -2·8 to -5·5) and participants older than 50 years at baseline had declines of -4·9% (-3·1 to -6·8). In multivariate models, age and baseline creatinine clearance less than 90 mL/min predicted declines in renal function. We identified a monotonic association between percentage decrease in creatinine clearance and the number of doses of tenofovir disoproxil fumarate and emtricitabine taken per week, as estimated by hair concentrations of tenofovir and emtricitabine (ptrend=0·008). INTERPRETATION Our data suggest that the frequency of safety monitoring for PrEP might need to be different between age groups and that pharmacological measures can monitor for toxic effects as well as adherence. FUNDING National Institutes of Health.
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Affiliation(s)
- Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - David V Glidden
- Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Mauro Schechter
- Projeto Praça Onze, Hospital Escola Sâo Francisco de Assis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clinica Evandro Chagas (IPEC) CRS, Rio De Janeiro, Brazil
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Martin Casapia
- Asociacion Civil Selva Amazonica (ACSA) CRS, Iquitos, Peru
| | | | - Linda-Gail Bekker
- Desmond Tutu Health Foundation, Faculty of Health Sciences, Cape Town, South Africa
| | - Alexander Louie
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Howard Horng
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Albert Liu
- HIV Prevention Intervention Studies Bridge HIV, San Francisco, CA, USA
| | - Robert M Grant
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
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Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, Rodolph M, Hodges-Mameletzis I, Grant RM. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 2016; 30:1973-83. [PMID: 27149090 PMCID: PMC4949005 DOI: 10.1097/qad.0000000000001145] [Citation(s) in RCA: 637] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Preexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes. DESIGN Rigorous systematic review and meta-analysis. METHODS A comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis. RESULTS Eighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness. CONCLUSION PrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk.
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Affiliation(s)
| | - Sarah L. Dalglish
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Baggaley
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Kevin R. O’Reilly
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | | | - Robert M. Grant
- HIV Department, World Health Organization, Switzerland; Gladstone Institutes and the University of California; San Francisco AIDS Foundation, San Francisco, California, USA
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Mehrotra ML, Glidden DV, McMahan V, Amico KR, Hosek S, Defechereux P, Mayer KH, Veloso VG, Bekker LG, Avelino-Silva VI, Schechter M, Grant RM. The Effect of Depressive Symptoms on Adherence to Daily Oral PrEP in Men who have Sex with Men and Transgender Women: A Marginal Structural Model Analysis of The iPrEx OLE Study. AIDS Behav 2016; 20:1527-34. [PMID: 27125241 DOI: 10.1007/s10461-016-1415-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cisgender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.
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Sevelius J, Deutsch MB, Glidden DV, Grant RM. PrEP adherence among trans women in Brazil—access needed for this key population – Authors' reply. The Lancet HIV 2016; 3:e200-1. [DOI: 10.1016/s2352-3018(16)30023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
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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.
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Glidden DV, Amico KR, Liu AY, Hosek SG, Anderson PL, Buchbinder SP, McMahan V, Mayer KH, David B, Schechter M, Grinsztejn B, Guanira J, Grant RM. Symptoms, Side Effects and Adherence in the iPrEx Open-Label Extension. Clin Infect Dis 2016; 62:1172-7. [PMID: 26797207 DOI: 10.1093/cid/ciw022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/13/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blinded clinical trials have reported a modest and transient "start-up syndrome" with initiation of tenofovir-based pre-exposure prophylaxis (PrEP). We evaluate this phenomenon and its effect on adherence in an open-label PrEP study. METHODS In the iPrEx open-label extension (OLE) study, an 18-month open-label, multi-site PrEP cohort taking daily oral co-formulated tenofovir/emtricitabine, we examined the prevalence and duration of PrEP-associated symptoms and their effect on adherence, assessed by drug levels in dried blood spots tested monthly for the first 3 months. RESULTS Symptom reports peaked within the first month, with 39% reporting potentially PrEP-related symptoms compared to 22% at baseline. Symptoms largely resolved to pre-PrEP levels by 3 months.Symptoms varied substantially in frequency by study site (range in 1-month symptoms: 11% to 70%). Nongastrointestinal (GI) symptoms were not associated with adherence (odds ratio [OR] = 1.2, 95% confidence interval [CI], .4-3.7); however, GI-associated symptoms in the first 4 weeks were inversely associated with adherence at 4 weeks (OR = 0.47, 95% CI, .23-.96). Reports of GI symptoms were associated with 7% (95% CI, 4%-11%) of suboptimal adherence in this cohort. CONCLUSIONS PrEP-associated symptoms in the open-label setting occur in a minority of users and largely resolve within 3 months. GI symptoms are associated with a modest reduction in PrEP adherence, but good adherence is possible even in the presence of frequent symptom reports. CLINICAL TRIALS REGISTRATION Clinicaltrials.govNCT00458393.
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Affiliation(s)
| | | | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, California
| | - Sybil G Hosek
- John Stroger Hospital of Cook County, Chicago, Illinois
| | | | | | | | - Kenneth H Mayer
- Fenway Health and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Burns David
- National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - Mauro Schechter
- Projeto Praça Onze, Hospital Escola São Francisco de Assis and Universidade Federal do Rio de Janeiro, and
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Fiocruz, Rio de Janeiro, Brazil
| | | | - Robert M Grant
- Gladstone Institute of Virology and San Francisco AIDS Foundation, California
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Abstract
PURPOSE OF REVIEW As demand for preexposure prophylaxis (PrEP) increases, we are learning more about what people want from sex and PrEP. RECENT FINDINGS PrEP demand has reached a tipping point in the USA and is increasing rapidly. Although the primary benefit of PrEP use is biological, to reduce risk of HIV infection, PrEP users often express an alternative set of social and emotional benefits that are provided by PrEP. These collateral benefits of PrEP have salience, affect, and are experienced in the present, which are compelling drivers of human behavior. PrEP use has been associated with feeling safe during sex, usually in contrast to ruminations related to fear of HIV or intimate partner violence or control. PrEP can create empowerment, or agency, defined as the capacity and autonomy to act on one's own behalf, because it provides control over one's vulnerability to HIV and relief to women and men who may otherwise worry about whether their partners will use a condom, take antiretroviral therapy, or disclose their HIV status accurately. Planning for sexual and social goals in calm moments is also empowering. These highly desired collateral benefits of PrEP could be undermined, or eliminated, if PrEP is implemented in ways that are coercive or that foment fear of sexual risk compensation, drug resistance, toxicity, or moral judgment. SUMMARY Current PrEP implementation provides direct and indirect benefits that are highly desired.
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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
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Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, Kallas EG, Chariyalertsak S, Grant RM. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV 2015; 2:e512-9. [PMID: 26614965 PMCID: PMC5111857 DOI: 10.1016/s2352-3018(15)00206-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [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: 04/21/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Abstract
Background Oral emtricitabine-tenofovir disoproxil fumarate (FTC/TDF) pre-exposure prophylaxis (PrEP) is used to prevent the sexual acquisition of HIV. Transgender women (TGW) have unique characteristics that may relate to PrEP use, effectiveness, and safety. Methods The iPrEx trial was a randomized controlled trial (RCT) of oral FTC/TDF PrEP versus placebo among men who have sex with men (MSM) and TGW, followed by an open label extension (OLE). Drug concentrations were measured in blood by liquid chromatography and tandem mass spectroscopy. Findings Of the 2499 participants enrolled in the RCT, 29 (1%) identified as women, 296 (12%) identified as “trans”, 14 (1%) identified as men but reported use of feminizing hormones, such that 339 (14%) reported one or more of these characteristics (TGW). Compared with MSM, TGW more frequently reported transactional sex, receptive anal intercourse without a condom, or more than 5 partners in the past 3 months. Among TGW, there were 11 HIV infections in the active arm and 10 in the placebo arm, representing a hazard ratio of 1.1 (95% CI: 0.5 to 2.7). Among active arm participants, drug was detected in none of the TGW at the seroconversion visit, 18% (6/37) of seronegative TGW (P=0.31), and 52% (58/111) of seronegative MSM (P < 0.0001). PrEP use was not linked to behavioral indicators of HIV risk among TGW, while MSM at highest risk were more adherent. Interpretation There were no HIV infections among TGW having drug concentrations commensurate with use of 4 or more FTC/TDF tablets per week. TGW receiving PrEP had low drug concentrations, especially at times of potential HIV exposure, leading to no PrEP effectiveness among this subgroup. Funding U.S. National Institutes of Health and the Bill and Melinda Gates Foundation; study medication was donated by Gilead Sciences.
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Affiliation(s)
| | | | - Jae Sevelius
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Robert M Grant
- University of California, San Francisco, CA, USA; Gladstone Institutes, San Francisco, CA, USA; San Francisco AIDS Foundation, San Francisco, CA, USA.
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Koester KA, Grant RM. Editorial Commentary: Keeping Our Eyes on the Prize: No New HIV Infections With Increased Use of HIV Pre-exposure Prophylaxis. Clin Infect Dis 2015; 61:1604-5. [PMID: 26334051 PMCID: PMC4614416 DOI: 10.1093/cid/civ783] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Robert M Grant
- University of California Gladstone Institutes San Francisco AIDS Foundation, California
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