PrEP use high, effective among HIV serodiscordant African couples
SEATTLE — Pre-exposure prophylaxis uptake among high-risk HIV serodiscordant couples in Africa appears to be high, and a time-limited approach to treatment nearly eliminated HIV transmission in this population, researchers reported here.
Renee Heffron, PhD, MPH, assistant professor of global health and epidemiology at the University of Washington, and colleagues evaluated high-risk, HIV serodiscordant couples enrolled in the Partners Demonstration Project in Kenya and Uganda between November 2012 and August 2014. In the open-label study, pre-exposure prophylaxis (PrEP) was offered as a “bridge” to ART in the serodiscordant relationship until the HIV-infected partner initiated ART and then for the next 6 months. The researchers gauged PrEP use based on pharmacy refills, and in a subgroup, the detection of Viread (tenofovir, Gilead Sciences) in plasma.
Two-thirds of the enrolled couples included HIV-uninfected male partners (median age, 30 years). Sixty-five percent of couples acknowledged having unprotected sex 1 month before enrollment.
The researchers found that overall, 95% of couples started PrEP at enrollment; among these, 97% were still using PrEP at their first follow-up visit 1 month after enrollment. For those couples still being followed at 6 months after enrollment and for whom the HIV-infected partner had not initiated ART, 91% continued to use PrEP. At 12 months, 84% of those same patients continued to use PrEP. The most common reasons for not using PrEP at 12 months included ART use by the infected partner (41%), loss to follow-up (30%), pregnancy and breast-feeding (9%), participant preference (8%) and partnership break-up (6%). Among 168 visits from 75 randomly selected PrEP recipients, tenofovir was detected in 86% of patients.
“People prescribed PrEP who were at high risk of HIV infection used the PrEP with high levels of adherence,” Heffron told Infectious Disease News.
Jared Baeten, MD, PhD, associate professor of global health at the University of Washington, also presented data from the Partners Demonstration Project, focusing on the efficacy of time-limited PrEP and ART for HIV prevention in more than 1,000 serodiscordant couples.
The researchers compared the observed HIV incidence with a counterfactual simulation model based on data from a prior prospective study of HIV serodiscordant couples.
Results of that study suggest the near elimination of HIV transmission, with HIV incidence lower than 0.5% per year, compared with an expected incidence of more than 5% per year.
“Our study is demonstrating a great model for couples to use PrEP and ART synergistically through this “bridging” strategy, which results in maximizing protection against HIV transmission and maintains that PrEP is not a lifelong intervention but for periods with high HIV risk,” Heffron said. – by Jen Byrne
Baeten J, et al. Abstract 24. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26; 2015; Seattle.
Heffron R, et al. Abstract 969. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26; 2015; Seattle.
Disclosure: Baeten and Heffron report no relevant financial disclosures.