Predictive factors for HIV infection among men who have sex with men and who are seeking PrEP: a secondary analysis of the PROUD trial. (27th March 2019)

• Record Type: Journal Article
• Authors: White, Ellen; Dunn, David T; Desai, Monica; Gafos, Mitzy; Kirwan, Peter; Sullivan, Ann K; Clarke, Amanda; McCormack, Sheena
• Other Names: author non-byline.; Dolling David I author non-byline.; Desai Monica author non-byline.; McOwan Alan author non-byline.; Gilson Richard author non-byline.; Clarke Amanda author non-byline.; Fisher Martin author non-byline.; Schembri Gabriel author non-byline.; Sullivan Ann K author non-byline.; Mackie Nicola author non-byline.; Reeves Iain author non-byline.; Portman Mags author non-byline.; Saunders John author non-byline.; Fox Julie author non-byline.; Bayley Jake author non-byline.; Brady Michael author non-byline.; Bowman Christine author non-byline.; Lacey Charles J author non-byline.; Taylor Stephen author non-byline.; White David author non-byline.; Antonucci Simone author non-byline.; Gafos Mitzy author non-byline.; McCormack Sheena author non-byline.; Gill Owen N author non-byline.; Dunn David T author non-byline.; Nardone Anthony author non-byline.; Apea Vanessa author non-byline.; Clark Drew author non-byline.; Davis Paul author non-byline.; Hand James author non-byline.; Hunt Machel author non-byline.; Neale Rebecca author non-byline.; O'Connell Jackie author non-byline.; Portman Margaret author non-byline.; Sarner Liat author non-byline.; Saunders John author non-byline.; Terry Louise author non-byline.; Twumasi Angelina author non-byline.; Tsui Salina author non-byline.; Vijeratnam Dayan author non-byline.; Whyte Ryan author non-byline.; Williams Andy author non-byline.; Gately Sian author non-byline.; Gilleran Gerry author non-byline.; Lyons Jill author non-byline.; McCormack Chris author non-byline.; Moore Katy author non-byline.; Stretton Cathy author non-byline.; Taylor Stephen author non-byline.; White David author non-byline.; Acheampong Alex author non-byline.; Bramley Michael author non-byline.; Campbell Marion author non-byline.; Chowdhry Ruby author non-byline.; Clarke Amanda author non-byline.; Eastwood Stewart author non-byline.; Fennell Babs author non-byline.; Fisher Martin author non-byline.; Hadley Wendy author non-byline.; Hobbs Kerry author non-byline.; Kirk Sarah author non-byline.; Perry Nicky author non-byline.; Rawlinson Charlotte author non-byline.; Richardson Celia author non-byline.; Richardson Claire author non-byline.; Roche Mark author non-byline.; Simpkin Emma author non-byline.; Shaw Simon author non-byline.; Souto Elisa author non-byline.; Williams Julia author non-byline.; Youssef Elaney author non-byline.; Antonucci Simone author non-byline.; Barber Tristan author non-byline.; Eliot Cindy author non-byline.; Fedele Serge author non-byline.; Higgs Chris author non-byline.; McCormick Kathryn author non-byline.; McCormack Sheena author non-byline.; McOwan Alan author non-byline.; Meijer Alexandra author non-byline.; Pepper Sam author non-byline.; Rowlands Jane author non-byline.; Singh Gurmit author non-byline.; SolerCarracedo Alfredo author non-byline.; Sonecha Sonali author non-byline.; Sullivan Ann author non-byline.; Taylor David author non-byline.; Thomas Lervina author non-byline.; Attakora Frederick author non-byline.; Bourke Marina author non-byline.; Castles Richard author non-byline.; Clark Rebecca author non-byline.; De-Masi Anke author non-byline.; Espa Veronica author non-byline.; Hungwe Rumbidzai author non-byline.; Lincoln Martin author non-byline.; Mguni Sifiso author non-byline.; Nevin-Dolan Rhianon author non-byline.; Reeves Iain author non-byline.; Alexander Hannah author non-byline.; Bayley Jake author non-byline.; Brady Michael author non-byline.; Campbell Lucy author non-byline.; Candfield Sophie author non-byline.; Doshi Shema author non-byline.; Liddle Olivia author non-byline.; Mulka Larissa author non-byline.; Saigal Priyanka author non-byline.; Stevenson James author non-byline.; Boateng James author non-byline.; Chappell Brynn author non-byline.; Currie Susanna author non-byline.; Davies Carolyn author non-byline.; Lebari Dornubari author non-byline.; Phillips Matthew author non-byline.; Schembri Gabriel author non-byline.; Southon Lisa author non-byline.; Thorpe Sarah author non-byline.; Vas Anna author non-byline.; Ward Chris author non-byline.; Warren Claire author non-byline.; Yau Stephanie author non-byline.; Arenas-Pinto Alejandro author non-byline.; Ashraf Asma author non-byline.; Bolton Matthew author non-byline.; Gilson Richard author non-byline.; Haddow Lewis author non-byline.; McNamara Sara author non-byline.; Milinkovic Ana author non-byline.; Minton June author non-byline.; Morris Dianne author non-byline.; Oakland Clare author non-byline.; O'Farrell Steve author non-byline.; Pellegrino Pierre author non-byline.; Pett Sarah author non-byline.; Vora Nina author non-byline.; Young Carmel author non-byline.; Zarko-Flynn Taris author non-byline.; Ayap Wilbert author non-byline.; Chen Ling Jun author non-byline.; Croucher Adam author non-byline.; Fidler Sarah author non-byline.; Kuldanek Kristin author non-byline.; Legg Ken author non-byline.; Leon Agathe author non-byline.; Mackie Nicola author non-byline.; Naous Nadia author non-byline.; Quinn Killian author non-byline.; Rey Severine author non-byline.; Zhou Judith author non-byline.; Bevan Margaret-Anne author non-byline.; Fox Julie author non-byline.; Francia Nina author non-byline.; Hamlyn Eleanor author non-byline.; Hurley Lisa author non-byline.; Iveson Helen author non-byline.; Jendrulek Isabelle author non-byline.; Murray Tammy author non-byline.; Sharp Alice author non-byline.; Skingsley Andrew author non-byline.; Tam Chi Kai author non-byline.; Al Teague Caroline Thomas author non-byline.; Tiraboschi Juan-Manuel author non-byline.; Brewer Christine author non-byline.; Evans Richard author non-byline.; Gravely Jan author non-byline.; Lacey Charles author non-byline.; Lamont Gary author non-byline.; Martin Fabiola author non-byline.; Morris Georgina author non-byline.; Russell-Sharpe Sarah author non-byline.; Wightman John author non-byline.; Bains Anthony author non-byline.; Bell Gill author non-byline.; Bowman Christine author non-byline.; Cox Terry author non-byline.; Dewsnap Claire author non-byline.; Hughes Charlie author non-byline.; Loftus Hannah author non-byline.; Sutton Naomi author non-byline.; Talbot Debbie author non-byline.; Tucker Vince author non-byline.; Banbury Sarah author non-byline.; Brodnicki Elizabeth author non-byline.; Chung Christina author non-byline.; Dolling David I author non-byline.; Dunn David T author non-byline.; Fairbrother Keith author non-byline.; Gabriel Michelle author non-byline.; Gafos Mitzy author non-byline.; Khan Sajad author non-byline.; Khan Shabana author non-byline.; McCormack Sheena author non-byline.; Mauger Brendan author non-byline.; Sancha Gemma author non-byline.; South Annabelle author non-byline.; Sowunmi Yinka author non-byline.; Spencer Susan author non-byline.; White Ellen author non-byline.; Bell Gill author non-byline.; Rae Caroline author non-byline.; Rayment Michael author non-byline.; Nutland Will author non-byline.; Wayal Sonali author non-byline.; Desai Monica author non-byline.; Desai Sarika author non-byline.; Field Nigel author non-byline.; Gill Noel author non-byline.; Hyland Kate author non-byline.; Kirwan Peter author non-byline.; Nardone Anthony author non-byline.; Seyan Parnam author non-byline.; Clarke Rich author non-byline.; Rooney Jim author non-byline.;
• Is Part Of: Sexually transmitted infections. Volume 95:issue 6(2019)
• Page Start: 449
• Page End: 454
• Publication Date: 2019-03-27
• Subjects: HIV -- MSM -- PrEP -- eligibility criteria; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2018-053808
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Objectives: Pre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention for men who have sex with men (MSM). However, uncertainty remains around the optimal eligibility criteria for PrEP, specifically whether there are subgroups at low risk of HIV for whom PrEP might not be warranted. Methods: PROUD was an open-label waitlist trial design that randomised MSM attending participating sexual health centres in England to receive PrEP immediately (IMM) or after a deferral period of 1 year (DEF). This analysis is based on participants who were randomised to the deferred arm, when they did not have access to PrEP. HIV incidence was compared between subgroups defined by baseline characteristics. Results: Overall, 21 participants acquired HIV infection over 239.3 person-years (PY) follow-up, yielding an incidence rate of 8.8/100 PY (95% CI 5.4 to 13.4). Two highly significant predictors for HIV acquisition were identified. Men with a self-reported diagnosis of syphilis, rectal chlamydia (CT) or rectal gonorrhoea (GC) in the previous 12 months had an incidence of 17.2/100 PY (95% CI 9.7 to 28.5); those reporting receptive anal intercourse without a condom (ncRAI) with two or more partners in the previous 3 months had an incidence of 13.6/100 PY (95% CI 7.9 to 21.7). The incidence rate among participants lacking both of these risk factors was 1.1/100 PY (1/87.6, 95% CI 0.03 to 6.4). Conclusions: The high HIV incidence in PROUD suggests that most participants appropriately judged their need for PrEP. Eligibility criteria for a PrEP programme can therefore be broad, as in the current guidelines. However, a recent history of syphilis or rectal CT/GC, or multiple ncRAI partners indicates a high imminent risk of HIV infection. MSM with any of these characteristics should be offered PrEP as a matter of urgency.