Abstract
BackgroundHIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat’AIDS cohort in 2016.MethodsMulticenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area.ResultsAmong 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%).ConclusionWith 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.
Highlights
HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection
This multicenter retrospective analysis was performed in the French Dat’AIDS Cohort (NCT 02898987 ClinicalTrials.gov). This cohort represents a collaboration between 21 major French HIV clinical centers using a common electronic medical record (NADIS®) [10] for the follow-up of HIV infected adults coinfected or not with hepatitis B virus (HBV) and hepatitis C virus (HCV), among which data from 59,829 patients were collected during the year 2016
PrEP area vs pre-PrEP area infected patients Compared to the patients infected in the PrEP area, those infected in the pre-PrEP area were significantly older and were more often women from west or central Africa and infected by heterosexual intercourse
Summary
HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. The dynamic of the epidemic is mainly driven by men who have sex with men (MSM) (44% of new HIV diagnosis) and by the migrant women’s population (23%), mainly from sub-Saharan African countries [1]. HIV pre-exposure prophylaxis is an effective tool in preventing HIV infection among high-risk men who have sex with men. PrEP was implemented since November 25, 2015, first as part of a Temporary Recommendation for Use (TRU) [5] based on individual-level risk factors for HIV infection, followed by a marketing authorization extension without advance fees for the patient in February 2017 [6]
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