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Abstract

Introduction

Guidelines for pre-exposure prophylaxis (PrEP) provide criteria to identify individuals at higher risk of HIV infection. We compared the ability to predict HIV seroconversion of four guidelines: the World Health Organization (WHO), the United States Public Health Service and Centers for Disease Control and Prevention (US CDC), the European AIDS Clinical Society (EACS) and the Portuguese National Health Service (PNHS).

Aim

We aimed to measure the association between guideline-specific eligibility and HIV seroconversion.

Methods

We studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion.

Results

We found 28 incident cases (IR: 1.62/100 PY; 95% confidence interval (CI) 1.12–2.35). Guidelines’ sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46/100 PY; IRR = 4.61; 95% CI: 1.60–13.27) and lowest for the WHO guideline (1.89/100 PY; IRR = 1.52; 95% CI: 0.69–3.35).

Conclusions

Being identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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/content/10.2807/1560-7917.ES.2020.25.28.1900636
2020-07-16
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.28.1900636
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References

  1. Piot P, Bartos M, Larson H, Zewdie D, Mane P. Coming to terms with complexity: a call to action for HIV prevention. Lancet. 2008;372(9641):845-59.  https://doi.org/10.1016/S0140-6736(08)60888-0  PMID: 18687458 
  2. Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8(1):62-72.  https://doi.org/10.1007/s11904-010-0063-3  PMID: 20941553 
  3. Chang LW, Serwadda D, Quinn TC, Wawer MJ, Gray RH, Reynolds SJ. Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects. Lancet Infect Dis. 2013;13(1):65-76.  https://doi.org/10.1016/S1473-3099(12)70273-6  PMID: 23257232 
  4. Jones A, Cremin I, Abdullah F, Idoko J, Cherutich P, Kilonzo N, et al. Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention. Lancet. 2014;384(9939):272-9.  https://doi.org/10.1016/S0140-6736(13)62230-8  PMID: 24740087 
  5. Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, et al. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis. 2018;18(1):85-94.  https://doi.org/10.1016/S1473-3099(17)30540-6  PMID: 29054789 
  6. Menza TW, Hughes JP, Celum CL, Golden MR. Prediction of HIV acquisition among men who have sex with men. Sex Transm Dis. 2009;36(9):547-55.  https://doi.org/10.1097/OLQ.0b013e3181a9cc41  PMID: 19707108 
  7. Smith DK, Pals SL, Herbst JH, Shinde S, Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2012;60(4):421-7.  https://doi.org/10.1097/QAI.0b013e318256b2f6  PMID: 22487585 
  8. Hoenigl M, Weibel N, Mehta SR, Anderson CM, Jenks J, Green N, et al. Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis. 2015;61(3):468-75.  https://doi.org/10.1093/cid/civ335  PMID: 25904374 
  9. Beymer MR, Weiss RE, Sugar CA, Bourque LB, Gee GC, Morisky DE, et al. Are centers for disease control and prevention guidelines for preexposure prophylaxis specific enough? formulation of a personalized HIV risk score for pre-exposure prophylaxis initiation. Sex Transm Dis. 2017;44(1):48-56.  https://doi.org/10.1097/OLQ.0000000000000535  PMID: 27898570 
  10. Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, et al. Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019;321(22):2214-30.  https://doi.org/10.1001/jama.2019.2591  PMID: 31184746 
  11. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-99.  https://doi.org/10.1056/NEJMoa1011205  PMID: 21091279 
  12. Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237-46.  https://doi.org/10.1056/NEJMoa1506273  PMID: 26624850 
  13. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60.  https://doi.org/10.1016/S0140-6736(15)00056-2  PMID: 26364263 
  14. Meireles P, Plankey M, Rocha M, Rojas J, Brito J, Barros H. Eligibility for pre-exposure prophylaxis according to different guidelines in a cohort of HIV-negative men who have sex with men in Lisbon, Portugal. Sex Res Soc Policy. 2020.
  15. Hoots BE, Finlayson T, Nerlander L, Paz-Bailey G, National HIV Behavioral Surveillance Study Group. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US cities, 2014. Clin Infect Dis. 2016;63(5):672-7.  https://doi.org/10.1093/cid/ciw367  PMID: 27282710 
  16. Lancki N, Almirol E, Alon L, McNulty M, Schneider JA. Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago. AIDS. 2018;32(3):383-92. PMID: 29194116 
  17. Calabrese SK, Willie TC, Galvao RW, Tekeste M, Dovidio JF, Safon CB, et al. Current US guidelines for prescribing HIV pre-exposure prophylaxis (PrEP) disqualify many women who are at risk and motivated to use PrEP. J Acquir Immune Defic Syndr. 2019;81(4):395-405.  https://doi.org/10.1097/QAI.0000000000002042  PMID: 30973543 
  18. Meireles P, Lucas R, Carvalho C, Fuertes R, Brito J, Campos MJ, et al. Incident risk factors as predictors of HIV seroconversion in the Lisbon cohort of men who have sex with men: first results, 2011-2014. Euro Surveill. 2015;20(14):21091.  https://doi.org/10.2807/1560-7917.ES2015.20.14.21091  PMID: 25884151 
  19. Meireles P, Lucas R, Martins A, Carvalho AC, Fuertes R, Brito J, et al. The Lisbon Cohort of men who have sex with men. BMJ Open. 2015;5(5):e007220.  https://doi.org/10.1136/bmjopen-2014-007220  PMID: 25967995 
  20. World Health Organization (WHO). WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection. Module 1: Clinical. Geneva: WHO; 2017. (WHO/HIV/2017.17). Available from: https://www.who.int/hiv/pub/prep/prep-implementation-tool/en/
  21. Centers for Disease Control and Prevention (CDC). US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline. Atlanta: CDC; 2017. Available from: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
  22. European AIDS Clinical Society (EACS). Guidelines 9.0. Brussels: EACS; 2017. Available from: https://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html
  23. Direção-Geral da Saúde. Norma n° 025/2017 de 28/11/2017 atualizada a 16/05/2018. [Portuguese Directorate-General of Health. Norm No. 025/2017 of 28/11/2017 updated in 16/05/2018]. Lisbon: Ministry of Health, 2018. Portuguese. Available from: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0252017-de-28112017-pdf.aspx
  24. Molina J-M, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402-10.  https://doi.org/10.1016/S2352-3018(17)30089-9  PMID: 28747274 
  25. Xiridou M, Geskus R, De Wit J, Coutinho R, Kretzschmar M. The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS. 2003;17(7):1029-38.  https://doi.org/10.1097/00002030-200305020-00012  PMID: 12700453 
  26. Lavoie E, Alary M, Remis RS, Otis J, Vincelette J, Turmel B, et al. Determinants of HIV seroconversion among men who have sex with men living in a low HIV incidence population in the era of highly active antiretroviral therapies. Sex Transm Dis. 2008;35(1):25-9.  https://doi.org/10.1097/OLQ.0b013e31814fb113  PMID: 17898678 
  27. Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731-9.  https://doi.org/10.1097/01.aids.0000216374.61442.55  PMID: 16514304 
  28. Poynten IM, Jin F, Prestage GP, Kaldor JM, Kippax S, Grulich AE. Defining high HIV incidence subgroups of Australian homosexual men: implications for conducting HIV prevention trials in low HIV prevalence settings. HIV Med. 2010;11(10):635-41.  https://doi.org/10.1111/j.1468-1293.2010.00833.x  PMID: 20456511 
  29. Ayerdi Aguirrebengoa O, Vera García M, Portocarrero Nuñez JA, Puerta López T, García Lotero M, Escalante Garcia C, et al. La implementación de la profilaxis preexposición podría evitar la mayoría de las nuevas infecciones por el VIH en hombres que tienen sexo con hombres y mujeres transexuales. [Implementing pre-exposure prophylaxis could prevent most new HIV infections in transsexual women and men who have sex with men]. Rev Clin Esp. 2019;219(7):360-6. Spanish.  https://doi.org/10.1016/j.rce.2019.02.001  PMID: 30982539 
  30. Cornelisse VJ, Fairley CK, Stoove M, Asselin J, Chow EPF, Price B, et al. Evaluation of preexposure (PrEP) eligibility criteria, using sexually transmissible infections as markers of human immunodeficiency virus (HIV) risk at enrollment in PrEPX, a large Australian HIV PrEP trial. Clin Infect Dis. 2018;67(12):1847-52.  https://doi.org/10.1093/cid/ciy370  PMID: 29741665 
  31. Krakower DS, Gruber S, Hsu K, Menchaca JT, Maro JC, Kruskal BA, et al. Development and validation of an automated HIV prediction algorithm to identify candidates for pre-exposure prophylaxis: a modelling study. Lancet HIV. 2019;6(10):e696-704.  https://doi.org/10.1016/S2352-3018(19)30139-0  PMID: 31285182 
  32. Krakower DS, Ware NC, Maloney KM, Wilson IB, Wong JB, Mayer KH. Differing experiences with pre-exposure prophylaxis in boston among lesbian, gay, bisexual, and transgender specialists and generalists in primary care: implications for scale-up. AIDS Patient Care STDS. 2017;31(7):297-304.  https://doi.org/10.1089/apc.2017.0031  PMID: 28574774 
  33. Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, et al. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018. J Virus Erad. 2018;4(3):143-59. PMID: 30050676 
  34. Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, Vaughan A, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS One. 2014;9(3):e90514.  https://doi.org/10.1371/journal.pone.0090514  PMID: 24608176 
Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014–2018
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Paula+Meireles&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meireles Paula</a>, <a href="/search?value1=Michael+Plankey&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Plankey Michael</a>, <a href="/search?value1=Miguel+Rocha&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rocha Miguel</a>, <a href="/search?value1=Jo%C3%A3o+Brito&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brito João</a>, <a href="/search?value1=Lu%C3%ADs+Mend%C3%A3o&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mendão Luís</a>, <a href="/search?value1=Henrique+Barros&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Barros Henrique</a></span>. Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014–2018. <a href="/content/ecdc">Euro Surveill.</a> 2020;25(28):pii=1900636. <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.28.1900636" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2020.25.28.1900636</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 11 Oct 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 15 May 2020 </span> </p>
/content/10.2807/1560-7917.ES.2020.25.28.1900636
/content/10.2807/1560-7917.ES.2020.25.28.1900636
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