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Which men stand to benefit most from access to PrEP?
Michael Carter, 2016-05-03 13:00:00
New data from the
PROUD pre-exposure prophylaxis (PrEP) study have identified the characteristics
of the gay and other men who have sex men who are most likely to benefit from PrEP.
Study participants were randomised to receive immediate or deferred PrEP. Analysis
of the baseline sexual characteristics of men in the deferred arm who became infected
with HIV showed that a rectal sexually transmitted infection (STI) and
reporting recent unprotected anal sex with two or more partners were associated
with especially high HIV incidence rates. Findings were reported to the recent
conference of the British HIV Association (BHIVA) in Manchester.
The PROUD trial
recruited 544 MSM in the UK. They were randomised to receive either immediate
PrEP or deferred treatment. There were no infections in the PrEP arm.
In the present
analysis, investigators focused their attention on men in the deferred arm who
became infected with HIV. Their aim was to identify the characteristics of men
at highest risk of HIV who would most benefit from PrEP. They considered
baseline characteristics including diagnosis with a rectal STI, number of recent
unprotected receptive anal sex partners, use of drugs during sex (Chemsex), use
of post-exposure prophylaxis (PEP) and relationship status.
A total of 253 of the 269 men assigned to the deferred arm were included in the analysis; 13 men randomised to the deferred arm were excluded due to lack of follow up HIV test results, two due to co-enrollment at multiple sites and one due to HIV positivity at baseline visit. These individuals
contributed 220 person-years of follow-up. There were 20 HIV infections, an
incidence rate of 9.1 per 100 person-years.
characteristics significantly associated with diagnosis with HIV were a rectal
STI (p = 0.01) and unprotected receptive anal sex with two or more partners (p
Twelve men who seroconverted
had a baseline rectal STI. They contributed 69 person-years of follow-up, and
had an HIV incidence rate of 17.4 per 100 person-years.
A total of 18 men who
became infected with HIV reported recent unprotected receptive anal intercourse,
and six of these individuals had unprotected receptive sex with two or more
partners. They contributed 132
person-years of follow-up and had an incidence rate of 13.6 per 100
Incidence was also
higher among men reporting use of PEP (12.5 per 100 person-years) and Chemsex
(11.6 per 100 person-years), but the higher incidence associated with each of these characteristics was not statistically significant. Nevertheless, the researchers said that all the risk factors examined placed men at above the level of `substantial risk` identified by the World Health Organization as indicating the need for PrEP.
conclude by noting guidance from the General Medical Council that states that
it is a doctor’s duty to explain the risk of HIV to patients and to provide
them with information on all options to reduce their risk. “This has to include
PrEP,” state the researchers.