Characteristics of HIV pre-exposure prophylaxis users at first PrEP counselling visit: the CSL-PrEP cohort

Abstract

ObjectivesPre-exposure prophylaxis (PrEP) is effective for HIV prevention and is mostly used by men who have sex with men (MSM). The aim of this study was to describe the characteristics of a cohort of PrEP users at first PrEP counselling visits (baseline, BL).DesignCross-sectional study of a cohort of MSM receiving PrEP (Centro San Luigi, CSL-PrEP Cohort).SettingSecondary-level sexually transmitted infections (STI) centre in Milan, Italy, from May 2017 to May 2022.ParticipantsOverall, 624 MSM PrEP users were included; most users were Caucasian (97%), attended university (64%), with a median BL age of 34.5 years.ResultsOverall, 45% choose the daily-based PrEP regimen, 55% the event-based one. An increasing trend in PrEP counselling visits was observed (p=0.024). The majority had between 10 and 19 partners in the 3 months before BL and 41% were chemsex users. All had a HIV Incidence Risk Index for MSM (HIRI-MSM)>10, 54% between 20 and 29. Overall, 50% had ≥1 previous STI and 22% ≥1 BL STI. BL chlamydia (10%) was often more frequent than in the past (7%). The number of sexual partners was associated with BL chlamydia (p<0.001), gonorrhoea (p=0.002) and syphilis (p=<0.001), HIRI-MSM with chlamydia (p=0.001) and gonorrhoea (p=0.008), chemsex use with chlamydia (p=0.003) and gonorrhoea (p=0.030).ConclusionsWe observed an unbalanced access to PrEP in respect to all key populations which might benefit from PrEP, with a similar choice for event-based or daily-based regimens. High-risk behaviours and STIs were frequently observed. History of chlamydia was very frequently high in asymptomatic MSM at BL, compared with what observed before access to PrEP. High-risk behaviours and HIRI-MSM were associated with most of STIs.

Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination

“…Variables known to have a potential effect on the risk of lack of triple vaccination (HAV, HBV, and HPV) or those with a P value ,0.1 in univariable analyses were entered in the multivariable model. [5][6][7] A 2-sided P value , 0.05 was considered statistically significant. Analyses were performed using SAS, version 9.4 (SAS Institute, Cary, NC).…”

“…[1][2][3][4] High-risk sexual behaviors are common among MSM PrEP users, including high number of partners, lack of use of barrier methods, and chemsex. [1][2][3][4][5][6][7] For instance, HPV incidence is higher among MSM who receive PrEP, compared with other key populations. 2,8 HAV has caused outbreaks among MSM in the past years.…”

Meningococcus B Vaccination Effectiveness Against Neisseria gonorrhoeae Infection in People Living With HIV: A Case-Control Study

“…19 This was found to be true among MSM also in the Italian setting and specifically in the area of Milan; for instance, Milan is one of the Italian cities with the highest number of new HIV diagnoses, pre-xposure prophylaxis users, and STIs. [20][21][22] Reducing gonorrhea cases among PLWH is therefore a priority, from both an individual and a public health perspective, given the substantial decrease in quality of life and morbidity resulting from infections. 1 Therefore, an open question is whether 4CMenB effectiveness against gonorrhea is confirmed also among PLWH.…”

“…People living with HIV and men who have sex with men (MSM) are key populations where one of the highest burdens of STIs is observed, including gonorrhea 19 . This was found to be true among MSM also in the Italian setting and specifically in the area of Milan; for instance, Milan is one of the Italian cities with the highest number of new HIV diagnoses, pre-xposure prophylaxis users, and STIs 20–22 . Reducing gonorrhea cases among PLWH is therefore a priority, from both an individual and a public health perspective, given the substantial decrease in quality of life and morbidity resulting from infections 1 .…”