Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians

Antonio Palummieri,The Prepventhiv Italy Study Group ,Patrice Cacoub,Cristina Mussini,Vincenzo Puro,Éric Rosenthal,Gabriella De Carli

doi:10.1186/s12879-017-2819-5

Abstract

BackgroundBefore Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle.MethodsTwo anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013–January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing).ResultsEighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% “had heard” of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor.ConclusionsAt a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of PLWHA were aware of it, and approximately 10% reported PrEP use in their close circle, although they rarely shared their ARVs with uninfected people for this purpose. Official policies and PrEP availability, along with implementation programs, could avoid risks from uncontrolled PrEP procurement and self-administration practices.

Highlights

Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with human immunodeficiency virus (HIV)/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals
At a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of persons living with HIV/AIDS (PLWHA) were aware of it, and approximately 10% reported PrEP use in their close circle, they rarely shared their ARVs with uninfected people for this purpose
HIV physicians and patients Eighty-seven HIV physicians from 31 representative departments of Infectious Diseases in 13 Regions participated in the study; 56% were from a research institute/university

Summary

Introduction

Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. On the basis of the resulting high-quality evidence, in 2012 the U.S Food and Drug Administration (FDA) and in 2016 the European Medicines Agency (EMA) approved tenofovir-emtricitabine (TDF–FTC, Truvada®) for PrEP in adults at high risk for contracting HIV infection, and guidelines were issued recommending that oral PrEP (containing TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches [7,8,9]. Data from the U.S, Australia and France, suggested an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals before PrEP was officially recommended and made available, as identified through surveys of gay and bisexual men, and persons living with HIV/AIDS (PLWHA) [10,11,12]

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