HIV seroconversions tied to poor PrEP adherence
Click Here to Manage Email Alerts
People who seroconverted were insufficiently adherent to HIV PrEP despite being at high risk for acquiring HIV, according to a recent study.
“The goal of this study was to evaluate participants in a large HIV PrEP study who acquired HIV after being dispensed PrEP,” Nila J. Dharan, MD, FRACP, PhD, infectious disease physician at the Kirby Institute, told Healio. “We wanted to find out the reasons for why people acquired HIV in the setting of being dispensed PrEP, such as they did not take the medication as prescribed, they were infected with a virus resistant to the drug(s) in PrEP, or they were infected with HIV despite taking the medication as prescribed.”
Dharan added that given that the Expanded PrEP Implementation in Communities in New South Wales (EPIC-NSW) study — an implementation study of daily oral PrEP in people aged 18 years and older who were at high risk for acquiring HIV — is one of the largest PrEP studies to date, this study provided a unique opportunity to understand reasons for HIV acquisition among people receiving PrEP.
Through the EPIC-NSW study, Dharan and colleagues assessed these patients for seroconversions — defined as a positive HIV test by either antigen, antibody or detectable HIV viral load — after study enrollment. According to the study, insufficient adherence, measured by dispensing logs or participant self-report, was also assessed and tracked.
Overall, a total of 9,596 people were enrolled and started on PrEP between March 1, 2016, and April 30, 2018. Of these patients, 30 were diagnosed with HIV by March 31, 2019, with the average number of days from first PrEP dispensing to diagnosis being 409. According to the study, there was no evidence that participants who seroconverted had been sufficiently adherent to PrEP.
Study data showed that among the 11 participants with complete data on PrEP dispensing and who had seroconverted before April 30, 2018, none had been dispensed PrEP within 3 months of their HIV diagnosis.
Among the 29 who initiated taking PrEP, there were 22 (76%) with data confirming when they last took PrEP. Of these, 18 (82%) had stopped taking PrEP a month or more before their HIV diagnosis, one (5%) had presented to reinitiate PrEP after stopping and one (5%) had reinitiated PrEP but had a high-risk sexual event before completing their first week of PrEP dosing.
According to the study, the remaining two patients who were dispensed PrEP within a month of their HIV diagnosis were also not sufficiently adherent to daily PrEP — one was taking PrEP on demand but not according to guidelines, and the other reported inconsistent PrEP use throughout the study because of “periods of perceived lower risk.”
Dharan said these findings highlight several important areas for improvement in HIV prevention.
“First, clinicians prescribing PrEP should ensure that they discuss the circumstances of their patients to identify any potential barriers to the use of PrEP. Second, they should also discuss the use of PrEP, including stopping and starting PrEP, regularly and in detail with their patients to ensure their patients understand the risks HIV acquisition during times of perceived lower risk,” Dharan said. “Lastly, there are now new ‘demand’ regimens for taking PrEP, as well as long-acting injectable medications, which may be more suited for patients with intermittent periods of risk or difficulty remembering to take oral medications.”
Collapse
Read more about
Click Here to Manage Email Alerts