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26% of black MSM in PrEP trial diagnosed with STI during follow-up

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January 13, 2019

More than 26% of black men who have sex with men, or MSM, who were enrolled in a pre-exposure prophylaxis, or PrEP, trial were diagnosed with an STI in follow-up, and younger study participants had higher rates of STIs than older participants, according to research published in Clinical Infectious Diseases.

The study authors noted that the overall rates of STIs in the study were lower than prior PrEP trials and did not increase over time.

“The benefits of ‘treatment as prevention’ and other new biomedical prevention technologies are not distributed equally across subpopulations affected by HIV,” the researchers wrote. “Black communities continue to experience the most severe burden of HIV among all racial/ethnic groups in the U.S., with black men who have sex with men disproportionally impacted. ... Modeling studies have estimated that if the current trends continue, one in two [black MSM] will be diagnosed with HIV in his lifetime, and that if current incidence rates persist, 40% of [black MSM] will be HIV-infected by aged 30.”

The researchers enrolled 226 black MSM who were not infected with HIV in three U.S. cities, with all participants receiving client-centered care coordination and an offer of daily PrEP. The researchers followed the study participants for 1 year, testing them for gonorrhea, chlamydia and syphilis at baseline, week 26 and week 52, and measured associations between STI incidences and PrEP uptake.

At baseline, STI prevalence among study participants was 14.2%, with younger men (aged younger than 25 years) more likely to have an STI (25.3% vs. 6.7%; OR = 4.39; 95% CI, 1.91-10.11), the researchers reported. During the study, 60 men (26.5%) acquired at least one STI, with an incidence rate of 34.2 cases per 100 person-years (95% CI, 27.4-42.9 cases). Adjusted analyses found that baseline STI diagnosis (OR = 4.23; 95% CI, 1.82-9.87) and additional client-centered care coordination time (OR = 1.03: 95% CI, 1.00-1.06) were associated with having an incident STI, the researchers reported. However, STI incidence was not associated with participants’ PrEP acceptance or adherence, they found.

The researchers noted a “low overall rate of STI acquisition” compared with previous PrEP studies.

“The expansion of PrEP for HIV prevention provides a unique and timely opportunity to address the lack of progress to date in reducing HIV and STI incidence among [black MSM],” the researchers concluded. “Clearly, PrEP for [black MSM] must not be delivered ‘in isolation’ but rather as part of a combination prevention package that incorporates frequent STI screening and treatment and addresses [black MSM’s] pervasive ongoing exposure to adverse social and structural conditions, as well as a confluence of individual factors that continue to impact their overall health.” – by Bruce Thiel

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Disclosures: Please see the study for all authors’ relevant financial disclosures.

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