This Week in HIV Research: Don't Assume PrEP Use Increases STI Rates

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We've got a fascinating set of studies to share with you in this week's exploration of recently published HIV research. Most of this week's batch focuses on people with HIV under the age of 30, but with ramifications that may stretch well beyond that age group. Here's what we're looking at this time around:

  • Contrary to some earlier findings, a new study among young black men who have sex with men suggests no relationship between uptake of pre-exposure prophylaxis (PrEP) and increased sexually transmitted infection (STI) incidence.
  • Assigning people an HIV risk score doesn't necessarily make them any more keen to begin PrEP.
  • Youth-tailored HIV services may be effective at keeping young folks living with HIV in care -- but that doesn't necessarily translate to higher viral suppression.
  • Younger people living with HIV appear to be highly interested in long-acting antiretrovirals -- and the less frequent the dose, the more they're into them.

Join us for a closer look at each of these findings. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

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New Study Questions Impact of PrEP Use on STI Rates

Some studies have reported increasing rates of sexually transmitted infections (STIs) among people taking PrEP. However, a recent analysis of data from African-American men who have sex with men published in Clinical Infectious Diseases showed no such association.

All 226 study participants (median age 26) were offered PrEP, which 177 accepted at baseline. PrEP acceptance varied over the study period, as participants could start or stop biomedical prevention at any time up to week 48; at week 52, only 16% of PrEP accepters reported an adherence rate of 60% or higher. By week 52, the STI incidence rate was 35.2 per 100 person-years among people who accepted PrEP, compared to 31.5 per 100 person-years among people who did not, a difference that did not come close to statistical significance (P = .805). Incidence rates did not appear to rise during the follow-up period.

The provision of client-centered care coordination was central to the study. (Earlier studies had not included such a culturally tailored behavioral intervention.) Participants who required additional time for client-centered care coordination -- likely due to greater health or social needs -- were associated with slightly higher levels of incident STIs (adjusted OR 1.03). While no causal connection can be proven, authors suggested that the care coordination may have affected sexual behavior. Examination of other data points revealed that, similar to previous studies, the current study found that having an STI at baseline increased the likelihood of a subsequent STI (odds ratio 4.23).

Study authors hypothesized that the apparent connection between PrEP use and greater STI incidence found by other studies "may simply be a function of the risk profile of early adopters of PrEP" and "could also be an artifact of more frequent and consistent screening in this population." They recommended routine STI screening for people who take PrEP, independent of reported risk behaviors. They also called for providing services that address social and structural conditions, as well as individual factors, in addition to dispensing PrEP.

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Calculated HIV Risk Score Doesn't Affect PrEP Uptake

Providing an "objective" calculated risk score for HIV acquisition did little to persuade people that they should consider starting PrEP, a study published in the Journal of Acquired Immune Deficiency Syndromes showed.

One-hundred-seventy-one men who have sex with men and tested negative for HIV (median age 32; 37% identified as people of color) completed questionnaires from which each person's risk score was calculated. About half of participants (86) were given that score and the other half were not. Researchers called participants eight weeks later to find out whether they were on PrEP; at week 12, participants completed an online survey about their current risk behaviors.

Ten percent of the 135 people who were reached during the follow-up call had begun PrEP, with little difference between the two arms. At baseline, 38% of participants underestimated their HIV risk; self-perceived risk trended lower during follow-up.

That discrepancy between one's own perceived risk and one's actual risk may keep people from considering PrEP, study authors noted. "Nevertheless, because HIV risk perception may be slightly higher around HIV testing, HIV testing may be a crucial time to help correct misperceptions about HIV risk and acquisition and initiate same-day PrEP to facilitate greater uptake," they concluded.

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Age-Appropriate Focus Keeps Young People in HIV Care, but Doesn't Affect Viral Suppression

A program to retain at-risk young people in HIV care kept them coming back to the clinic, but that did not translate into higher rates of viral suppression than the standard of care, a study published in the Journal of Acquired Immune Deficiency Syndromes showed.

The program, Accessing Care Early (ACE), ran within an adult HIV clinic and enrolled 18- to 30-year-olds who had adherence barriers, such as a mental health diagnosis, or were transitioning from pediatric care. Researchers compared 61 ACE participants and 76 young people who were not eligible for the program.

After 24 months, 49% in the ACE arm and 26% in the standard of care group remained in care. Having more interactions with nurses and social workers was associated with greater likelihood of retention. "This finding underscores the importance of wraparound services and multidisciplinary care," study authors noted.

However, viral suppression rates were significantly lower among ACE participants than among the control group (60% vs. 89%). Authors concluded that young people with adherence challenges may benefit from additional programs and solutions, such as long-acting injectable HIV treatment.

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Young People With HIV Are Interested in Long-Acting Antiretrovirals

Young people would be interested in using long-acting antiretrovirals, provided any injections they have to receive are administered infrequently, a survey published in the Journal of Acquired Immune Deficiency Syndromes found.

Researchers asked 303 people under the age of 24 who received care at pediatric/adolescent HIV clinics in the U.S. about two hypothetical treatment options: intramuscular injections and subcutaneous implants. Overall, 88% said they would probably or definitively use the injectable form and 79% were interested in the implantable version.

The less frequent the injections, the higher the interest in that treatment option: 90% would get one shot every three months, but only 50% would want weekly injections, with monthly injections the threshold for definitely wanting to try this treatment modality.

Participants with high viral loads (>1,000 copies/mL) were more receptive to long-acting treatment options compared to those who were virally suppressed (prevalence ratio 1.12). The former group may have trouble adhering to daily oral treatment, study authors hypothesized.

"In sum, youth aged 13 to 24 years who are struggling to adhere to oral daily medications are a vulnerable niche population in whom [long-acting antiretrovirals] could serve as a critical strategy to improve clinical outcomes," they concluded.