July 29, 2015

U.S. PrEP Demo Project Finds People at Highest HIV Risk Take PrEP Most Consistently

Written by Gus Cairns

This post originally appeared on HIV and Hepatitis’ website.

An open-label demonstration project of Truvada pre-exposure prophylaxis (PrEP) in the U.S. has found generally high retention and adherence rates, with the highest adherence among people at the highest risk of HIV infection, researchers reported at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) last week in Vancouver. However, some groups appeared to have more difficulty taking PrEP — most notably young people and black people, and it proved difficult to recruit black men and transgender women — to the project.

The U.S. Demo Project previously released interim figures in 2014. In this study, 557 gay and bisexual men and transgender women in San Francisco, Miami, and Washington, DC, received PrEP on an open-label basis for a year.

The criteria for entry included (in the past 12 months): condomless anal sex with 2 or more partners, anal sex (with a condom or not) with 2 or more known HIV-positive partners, or diagnosis of syphilis, rectal gonorrhea, or chlamydia.

The average age of participants was 35 years, with 20% being under 25. 48% were white, 35% Latino, 7% black, and 10% mixed race or other. Just over half (54%) came forward specifically for the study, while the other 46% were referred by doctors during a check-up. Only 1.3% (7 individuals) were transgender women.

A high proportion of participants (24%) reported having a primary partner who was living with HIV (the viral load of HIV-positive partners was not specified), while 26% had a sexually transmitted infection (STI) diagnosed at baseline.

Retention in the study was good, with 78% of those originally enrolled remaining in the study at 12 months. 15% interrupted PrEP for reasons to do with side effects — mainly nausea or headache during the first month — but most resumed it again.

Not counting these interruptions, adherence as measured by drug levels was good, averaged over the whole study — roughly 85% throughout. 63% of participants had protective levels of PrEP (equivalent to at least 4 doses of Truvada a week) at all levels. Only 3% of study participants had drug levels that indicated fewer than 2 doses a week at all visits.

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