BHIVA 2016: Which Men Stand to Benefit Most from PrEP?


New data from the PROUD pre-exposure prophylaxis (PrEP) study have identified the characteristics of the gay and other men who have sex with men who are most likely to benefit from PrEP, according to findings reported at the recent conference of the British HIV Association (BHIVA) in Manchester. Gay men with rectal sexually transmitted infections (STIs) and those who had unprotected receptive anal sex with more partners were most likely to benefit from PrEP.

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The PROUD trial recruited 544 men who have sex men (MSM) in the U.K. They were randomized to receive either immediate PrEP or deferred treatment using once-daily tenofovir/emtricitabine (Truvada). As previously reported, there were no new HIV infections among men consistently taking PrEP in the immediate 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 randomized to the deferred arm were excluded due to lack of follow-up HIV test results, 2 due to co-enrollment at multiple sites, and 1 due to HIV positivity at baseline visit. These individuals contributed 220 person-years of follow-up. There were 20 HIV infections, for an incidence rate of 9.1 per 100 person-years.

Baseline characteristics significantly associated with diagnosis with HIV were having a rectal STI (p=0.01) and unprotected receptive anal sex with 2 or more partners (p=0.02).

There were 12 men who seroconverted who had a rectal STI at baseline. 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 6 of these had unprotected receptive sex with 2 or more partners. They contributed 132 person-years of follow-up and had an incidence rate of 13.6 per 100 person-years.

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.

The investigators concluded by noting guidance from the U.K. 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," they stated.



M Desai et al. Baseline Predictors of HIV Infection in the no-PrEP Group in the PROUD trial. 22nd Annual Conference of the British HIV Association(BHIVA 2016). Manchester, April 19-22, 2016. Abstract O24.