Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System—A Cohort Study

Hechter, Rulin C.; Bruxvoort, Katia; Zhou, Hui; Towner, William; Contreras, Richard; Schumacher, Christina; Grant, Donald C.; Jones, Joyce

doi:10.1097/qai.0000000000003015

Cited by 3 publications

(3 citation statements)

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“…The follow-up of PrEP users in Brazil revealed an incidence of 19.1 cases of acquired syphilis per 100 person-years (95% CI 18.4-19.9). This incidence can be considered relatively high against results from other cohorts of PrEP users in Australia (9.4 (9.0-9.8) /100 PA) [16], Canada (1.94 (0.73-5.12) /100 BP) [13], and the United States (7.8 (7.1-8.4) /100 BP) [17], but similar to findings in Denmark (21.7 /100 BP) [18] and Spain (15.99 (11.94-21.41) /100PA) [19]. These regional disparities need to be better investigated.…”

Section: Discussionmentioning

confidence: 92%

“…These findings may corroborate an increased vulnerability with the use of these substances. Hetcher et al [17] emphasizes that the relationship between the use of these substances and STIs needs to be examined more directly in order to understand the mechanisms that promote the vulnerability of individuals when they are using these substances. Indeed, understanding how these fragilities operate in the health-disease process for syphilis can facilitate management during PrEP to prevent this infection and other STIs.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

Pedrosa,

Pinheiro,

Filho

et al. 2024

Preprint

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Background: Acquired syphilis continues to affect millions of people around the world. It is crucial to study it in the context of HIV Pre-Exposure Prophylaxis (PrEP) to achieve the goals set out in the 2030 Agenda since the literature suggests increased risk behaviors for sexually transmitted infections. This study aimed to investigate the incidence and factors associated with acquired syphilis among PrEP users. Materials and methods: This retrospective cohort included data on PrEP users from all over Brazil from 2018 to 2020, obtained from the national antiretroviral logistics system. We calculated the proportion of syphilis before PrEP, the incidence during the user’s follow-up, reinfections, and their possible associated factors. We conducted descriptive, bivariate, and multivariate analysis, estimating the crude Relative Risk, adjusted Odds Ratio (aOR), and their respective confidence intervals (95%CI). Results: Most of the 34,000 individuals who started PrEP were male (89.0%), white (53.7%), self-identified as male (85.2%), homosexual, gay, or lesbian (72.2%), and had 12 schooling years or more (67.8%). Of these, 8.3% had syphilis in the six months before starting PrEP, and 4% had it in the first 30 days of using the prophylaxis. In the 19,820 individuals effectively monitored, the incidence of acquired syphilis was 19.1 cases per 100 person-years, and 1.9% of users had reinfection. The multivariate analysis identified female gender (aOR 0.3; 95%CI 0.2-0.5), being white or Black (aOR 0.9; 95%CI 0.7-0.9 and aOR 0.7; 95%CI 0.7-0.99, respectively) as protective factors for syphilis. Being homosexual, gay, lesbian (aOR 2.7; 95%CI 2.0-3.7) or having a history of syphilis in the six months before PrEP (aOR 2.2; 95%CI 1.9-2.5) were risk factors for syphilis during PrEP use. Behaviors related to the risk of syphilis included accepting something in exchange for sex (aOR 1.6; 95%CI 1.3-1.9), irregular condom use (use in less than half of sexual intercourse sessions; aOR 1.7; 95%CI 1.53-2.1) and recreational drug use (poppers; aOR 1.5; 95%CI 1.53-2.1). Conclusion: Syphilis in the context of PrEP has high rates and is associated with sociodemographic and behavioral factors. We recommend additional studies targeting prevention in this population to curb these figures.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

Pedrosa,

Pinheiro,

Filho

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Results from the open-label phase of DISCOVER also showed that PrEP users switching from TDF to TAF exhibited increase in eGFR (relative to baseline), while those who stayed on TAF had a relative decline [ 14 ]. However, the DISCOVER study population does not necessarily reflect the demographic characteristics of people on PrEP in the US [ 15 , 16 ], and it would be important to confirm findings in nontrial settings. In this retrospective cohort study using electronic health records (EHRs), we assessed changes in eGFR after switch from TDF to TAF in a matched cohort study where we compare TDF-to-TAF switchers to those who stayed on TDF.…”

mentioning

confidence: 99%

Changes in Glomerular Filtration Rate After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide Fumarate for Human Immunodeficiency Virus Preexposure Prophylaxis

Rivera,

Pak,

Mefford

et al. 2023

Open Forum Infectious Diseases

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Background Tenofovir alafenamide fumarate (TAF) was promoted as a safer alternative to tenofovir disoproxil fumarate (TDF) for HIV oral pre-exposure prophylaxis (PrEP). It is unknown if switching from TDF to TAF translates to improved renal function. We used electronic health records (EHR) data to assess changes in creatinine-estimated glomerular filtration rate (eGFR) after switching from TDF to TAF. Methods We conducted a retrospective cohort study using EHR data from Kaiser Permanente Southern California. We identified individuals who switched from TDF to TAF between October 2019-May 2022 and used time-varying propensity score matching to identified controls who were on TDF (“non-switchers”). We then used Bayesian longitudinal modeling to compare differences in eGFR between switching and non-switching scenarios. Results Among 5,246 eligible individuals, we included 118 TDF-to-TAF switchers and 114 non-switchers. Compared to non-switchers, switchers had older age of starting TDF but similar weights at index date. A higher proportion of switchers were White, on Medicare or Medicaid. and had dyslipidemia at index date. Switching to TAF was associated with a higher eGFR compared to staying on TDF in 3-15 months post-switch, but the differences were not statistically significant. (e.g., month 9 difference: 1.27, 95% Credible interval: -1.35 to 3.89). While most of estimated changes showed eGFR increase associated with switching, most were less <2 eGFR units. Sensitivity analyses to address missingness or non-adherence showed similar results. Conclusion Switching from TDF to TAF for PrEP was associated with a non-significant increase in eGFR. Findings need to be confirmed using larger cohorts.

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Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

Pedrosa,

Pinheiro,

Filho

et al. 2024

PLoS ONE

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Background Acquired syphilis continues to affect millions of people around the world. It is crucial to study it in the context of HIV Pre-Exposure Prophylaxis (PrEP) to achieve the goals set out in the 2030 Agenda since the literature suggests increased risk behaviors for sexually transmitted infections. This study aimed to investigate the incidence and factors associated with acquired syphilis among PrEP users. Materials and methods This retrospective cohort included data on PrEP users from all over Brazil from 2018 to 2020, retrieved from the national antiretroviral logistics system. We calculated the proportion of syphilis before PrEP, the incidence during the user’s follow-up, reinfections, and their possible associated factors. We conducted descriptive, bivariate, and multivariate analysis, estimating the crude Relative Risk, adjusted Odds Ratio (aOR), and their respective confidence intervals (95%CI). Results Most of the 34,000 individuals who started PrEP were male (89.0%), white (53.7%), self-identified as male (85.2%), homosexual, gay, or lesbian (72.2%), and had 12 schooling years or more (67.8%). Of these, 8.3% had syphilis in the six months before starting PrEP, and 4% had it in the first 30 days of using the prophylaxis. We identified a loss-to-follow-up rate of 41.7%, although the loss and the cohort shared similar characteristics. The proportion of missed syphilis tests was high: 33.4% in the 30 days and 38.8% in the follow-up period. In the 19,820 individuals effectively monitored, the incidence of acquired syphilis was 19.1 cases per 100 person-years, and 1.9% of users had reinfection. The rate of missed syphilis tests at the 30-day follow-up was 33.4%, and the total follow-up test period was 38.8%. The multivariate analysis identified female gender (aOR 0.3; 95%CI 0.2–0.5), being white or Black (aOR 0.9; 95%CI 0.7–0.9 and aOR 0.7; 95%CI 0.7–0.99, respectively) as protective factors for syphilis. Being homosexual, gay, lesbian (aOR 2.7; 95%CI 2.0–3.7), or having a history of syphilis in the six months before PrEP (aOR 2.2; 95%CI 1.9–2.5) were risk factors for syphilis during PrEP use. Behaviors related to the risk of syphilis included accepting something in exchange for sex (aOR 1.6; 95%CI 1.3–1.9), irregular condom use (use in less than half of sexual intercourse sessions; aOR 1.7; 95%CI 1.53–2.1) and recreational drug use (poppers; aOR 1.5; 95%CI 1.53–2.1). Conclusion Syphilis in the context of PrEP has high rates and is associated with sociodemographic and behavioral factors. We recommend additional studies targeting prevention in this population to curb these figures.

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Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System—A Cohort Study

Cited by 3 publications

References 36 publications

Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

Changes in Glomerular Filtration Rate After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide Fumarate for Human Immunodeficiency Virus Preexposure Prophylaxis

Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users

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