BHIVA/BASHH guidelines on the use of HIV pre–exposure prophylaxis (PrEP) 2018

Brady, Michael; Rodger, Alison; Asboe, David; Cambiano, Valentina; Clutterbuck, Dan; Desai, Monica; Field, Nigel; Harbottle, Justin; Jamal, Zahra; McCormack, Sheena; Palfreeman, Adrian; Portman, Mags; Quinn, Killian; Tenant‐Flowers, Melinda; Wilkins, Ed; Young, Ingrid

doi:10.1111/hiv.12718

Cited by 51 publications

(80 citation statements)

References 122 publications

(302 reference statements)

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“…This observation suggests that residual transmission risk observed in the first 6 months was related to lack of suppression in blood rather than any genital tract viraemia. It is therefore important after starting ART to use preventive measures such as consistent condom use or PrEP 17 until viral load suppression in blood is fully and sustainably achieved.…”

Section: Discussionmentioning

confidence: 99%

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

et al. 2019

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Summary Background The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships. Methods The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2 extension (to April 30, 2018) recruited and followed up gay couples only. At study visits, data collection included sexual behaviour questionnaires, HIV testing (HIV-negative partner), and HIV-1 viral load testing (HIV-positive partner). If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and env sequences in both partners to identify linked transmissions. Couple-years of follow-up were eligible for inclusion if condomless sex was reported, use of pre-exposure prophylaxis or post-exposure prophylaxis was not reported by the HIV-negative partner, and the HIV-positive partner was virally suppressed (plasma HIV-1 RNA <200 copies per mL) at the most recent visit (within the past year). Incidence rate of HIV transmission was calculated as the number of phylogenetically linked HIV infections that occurred during eligible couple-years of follow-up divided by eligible couple-years of follow-up. Two-sided 95% CIs for the incidence rate of transmission were calculated using exact Poisson methods. Findings Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up). Interpretation Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless...

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Section: Discussionmentioning

confidence: 99%

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

et al. 2019

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“…Guidelines recommend transitioning MSM who are at continuous risk of HIV from use of PEP towards use of PrEP. 21 PrEP taken daily or on-demand before possible exposure is a highly effective strategy for reducing the risk of HIV acquisition among MSM who are at high and ongoing risk of infection. 21 PEP, on the other hand, is a short-term treatment and is to be used in emergency circumstances after recent HIV exposure (within 72 h).…”

Section: Discussionmentioning

confidence: 99%

“… 21 PrEP taken daily or on-demand before possible exposure is a highly effective strategy for reducing the risk of HIV acquisition among MSM who are at high and ongoing risk of infection. 21 PEP, on the other hand, is a short-term treatment and is to be used in emergency circumstances after recent HIV exposure (within 72 h). 22 Both PrEP and PEP should be a part of combination HIV prevention strategy.…”

Section: Discussionmentioning

confidence: 99%

Use of HIV pre-exposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study

Hanum

Cambiano

Sewell

et al. 2020

The Lancet Public Health

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Background Since October, 2017 (and until October, 2020), pre-exposure prophylaxis (PrEP) has only been available in England, UK, through the PrEP Impact Trial, by purchasing it from some genitourinary medicine clinics, or via online sources. Here we report changes from 2013 to 2018 in PrEP and postexposure prophylaxis (PEP) awareness and use among HIV-negative gay, bisexual, and other men who have sex with men (MSM) and assess predictors of PrEP initiation. Methods In the prospective cohort study Attitudes to, and Understanding of Risk of Acquisition of HIV 2 (AURAH2), MSM were recruited from three sexual health clinics in England: two in London and one in Brighton, UK. Men were eligible if they were aged 18 years or older and HIV-negative or of unknown HIV status. Participants self-completed a baseline paper questionnaire at one of the three clinics between July 30, 2013, and April 30, 2016, and were subsequently able to complete 4-monthly and annual online questionnaires, which were available between March 1, 2015, and March 31, 2018, and collected information on sociodemographics, health and wellbeing, HIV status, and sexual behaviours. PrEP and PEP use in the previous 12 months was obtained at baseline and in annual questionnaires. We assessed trends over calendar time in 3-month periods from first enrolment to the end of the study period (July–December, 2013, was counted as one period) in use of PrEP and PEP using generalised estimating equation logistic models. We used age-adjusted Poisson models to assess factors associated with PrEP initiation among participants who reported never having used PrEP at baseline. Findings 1162 men completed a baseline questionnaire, among whom the mean age was 34 years (SD 10·4), and of those with available data, 942 (82%) of 1150 were white, 1076 (94%) of 1150 were gay, and 857 (74%) of 1159 were university educated. 622 (54%) of 1162 men completed at least one follow-up online questionnaire, of whom 483 (78%) completed at least one annual questionnaire. Overall, PrEP use in the past year increased from 0% (none of 28 respondents) in July to December, 2013, to 43% (23 of 53) in January to March, 2018. The corresponding increase in PrEP use among men who reported condomless sex with two or more partners was from 0% (none of 13 respondents) to 78% (21 of 27). PEP use peaked in April to June, 2016, at 28% (41 of 147 respondents), but decreased thereafter to 8% (four of 53) in January to March, 2018. Among 460 men who had never used PrEP at baseline, predictors of initiating PrEP included age 40–44 years (incidence rate ratio [IRR] 4·25, 95% CI 1·14–15·79) and 45 years and older (3·59, 1·08–11·97) versus younger than 25 years; and after adjustment for age, recent HIV test (5·17, 1·89–14·08), condomless sex (5·01, 2·16–11·63), condomless sex with two or more partners (5·43, 2·99–9·86), group sex (1·69, 1·01–2·84), and non-injection chemsex-related drugs use (2·86, 1·67–4·91) in the past 3 months, PEP u...

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“…Additionally, trans people aged 25–49 years were more likely to report having an HIV test than younger participants, suggesting a possible HIV risk knowledge gap among younger trans people, or that younger trans people are less likely test due to a possible perceived lack of need. Three trans participants reported being on PrEP; this might reflect a lack of PrEP knowledge,7 or issues with access to PrEP for trans people, who have only recently been included in the UK PrEP provision guidelines 28…”

Section: Discussionmentioning

confidence: 99%

Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

Hibbert

Wolton

Weeks³

et al. 2019

BMJ Sex Reprod Health

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ObjectivesTrans people remain an understudied population in the UK, with unmet sexual health needs. The aim of this research was to identify possible barriers and facilitators for sexual health clinic attendance and HIV testing among trans people.MethodsLesbian, gay, bisexual and transgender (LGBT) participants from across the UK were invited to take part in a cross-sectional online survey through Facebook advertising (April–June 2018). Psychosocial and sexual factors associated with recent sexual health clinic attendance, and ever having an HIV test were examined using multivariate logistic regression.ResultsA total of 3007 cisgender and 500 trans participants completed the survey. Trans participants were less likely to attend a sexual health clinic than cisgender participants (27% vs 36%, p<0.001) and report ever having an HIV test (49% vs 64%, p<0.001). One trans participant reported living with HIV and three reported currently taking pre-exposure prophylaxis. Factors associated with trans sexual health clinic attendance were: living in London, having a relationship with multiple partners, engaging in condomless anal intercourse, greater life satisfaction, and having alcohol and/or drugs before sex. Being a person of colour, aged 25–49 years, in a relationship with multiple partners, condomless anal intercourse, lower body dissatisfaction, and having drugs before sex were associated with ever having an HIV test among trans participants.ConclusionsTrans people were less likely to attend sexual health services than cisgender people, and half of trans participants who reported condomless anal intercourse had never had an HIV test. Further research is needed to understand and improve uptake of sexual health services among trans people.

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BHIVA/BASHH guidelines on the use of HIV pre–exposure prophylaxis (PrEP) 2018

Cited by 51 publications

References 122 publications

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

Use of HIV pre-exposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study

Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

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