The incidence of HIV infections was "extremely low" in a demonstration pre-exposure prophylaxis (PrEP) project at community-based clinics in Miami, San Francisco and Washington, DC; and there were no new infections observed among bisexual men and men who have sex with men who took Truvada (tenofovir / emtricitabine) at least twice a week, according to a report in the January 26 edition of JAMA Internal Medicine.
Membership of the PrEP was higher among people with higher risk for HIV.
After PrEP using Truvada showed high daily efficacy for men who have sex with men and transsexual women in the international study iPrExl, Alfred Liu, starting at the San Francisco Department of Public Health and colleagues, who designed the PrEP demonstration project to explore its effectiveness in real-world clinical practice. The results of the study were previously announced in part at the International AIDS Society Conference on the pathogenesis of HIV in 2015 in Vancouver, treatment and prevention last July.
The PrEP demonstration project was carried out between October and February 2012 2015 3 in places: the Miami-Dade Downtown STD Clinic, San Francisco City Clinic, and Whitman Walker Health in Washington, DC. Together the sites registered coalesced 557 participants at risk for HIV infection. Just over half came looking for PrEP clinics while others were referred by providers. Before preparing the seroconversion rate in HIV among gay men in these annual clinics was exceeded in 2%.
The majority of participants (550) were gay or bisexual men and 7 were transsexual women. The mean age was 35 years, with one fifth of the group in an age group below 25. Nearly half (48%) were white, 35% were Latino, 7% were black and 10% were mestizos (...) or other race / ethnicity. About three-quarters reported recourse to recreational drugs. Risk factors included unprotected anal sex with two or more partners, anal sex with HIV-positive partners (including about a quarter with a positive primary partner), or carrying sexually transmitted infections (STIs). About a quarter had gonorrhea, syphilis or chlamydia in the initial screening. Participants had normal renal function at baseline, since tenofovir cause renal impairment.
All participants received Truvada's free daily pills on an open source (non-randomized) basis for 48 weeks. They had follow-up visits at 1, 3, 6, 9, and 12 months for serology testing for HIV testing and STI testing, clinical monitoring, counseling, and PrEP fractionation.
- 3 people were diagnosed as seropositive for HIV at the time of registration.
- 2 participants were infected with HIV during follow-up, with an incidence rate of 0,43 per 100 person-year; both had drug levels in the blood, suggesting they took PrEP less than twice a week.
- 79% of those enrolled were still keeping the PrEP at the end of the twelve-month period of study.
- About 15% of participants discontinued PrEP - temporarily in many cases - especially due to side effects (e.g., nausea, headache) or to realize in low risk.
- Grip as determined by tenofovir drug level in dried blood spots was about 85% overall, based on previous studies indicating that 4 doses per week They offer good protection levels.
- While the membership reached 90% in San Francisco and 88% in Washington, DC, it was only 65% in Miami.
- Participants reached grip 91% of white people, compared with 77% for Latinos and 57% for black participants.
- People homeless or in unstable housing have provided poor grip levels. But age, education, drugs and alcohol or did not.
- Participants who reported unprotected anal sex with more partners had a better grip (89% or more partners if 2 75% vs up 0-1 3 partners over the past months).
- The average number of anal sex partners decreased during follow-up of the 10,9 9,3.
- The proportion of people who had maintained receptive anal sex remained stable at about 66%, but participants were less likely to have sex com condoms with their length of time at increased PrEP.
- The presence of STIs had great overall incidence (90 100 by person-years) but did not increase over time; Liu reported earlier that the number of participants with STDs decreased during the first 6 months PrEP but rose again to the baseline level.
- The safety and tolerability of PrEP was generally good, with no serious adverse events related to the presence of Truvada.
- Less than 5% of participants experienced mild or moderate elevations of creatinine (a potential of renal function impairment signal), but these problems were resolved without stopping Truvada.
"The incidence of HIV acquisition was extremely low despite a high incidence of STIs in a large US PrEP demonstration project," the study authors concluded. "The adherence was greater among participants who reported higher risk behaviors. Interventions that racial origin and geographical disparities as well as instability of housing can increase the negative impact of PrEP. "
Translated by Claudio Souza's original in English In New HIV Infections Among Consistent Truvada PrEP Users in Demo Project in 21 / 1 / 16 (the link opens in another tab of your browser
Updating in 27 October 2018
I've never really felt comfortable with this "PrEP thing" and a few days ago I translated a text from the Betablog that is about "Friday PrEP Failure"! and, a little while ago, I had registered the "Second Failure In PrEP"
I would feel extremely uncomfortable in a hypothetical scenario with a partner in PrEP, even with "Undetectable Viral Load because there is a possibility"Viral blisters"Which is unpredictable to be perceived. A very high risk to be experienced, and has already been found, in fact were FOUND cases of undetectable people in the bloodstream and with the semen with high viral load and not inexpressive.
It causes me "kind"
AY Liu, SE Cohen, Vittinghoff et al. Prophylaxis for HIV infection Preexposure integrated with City Hall and participating sexual health services. The JAMA Internal Medicine 176 (1): 75-84. January 2016.