O2 An epidemiological analysis of men who have sex with men (msm) who are prescribed hiv post-exposure prophylaxis: implications for wider pre-exposure prophylaxis policy

Abstract

Background/introduction Post-exposure prophylaxis following sexual exposure (PEPSE) is a potential method of preventing HIV infection in certain circumstances. Initiation of PEPSE is recommended following receptive anal intercourse with a partner of known positive or unknown HIV status from a high risk group. Aim(s)/objectives To investigate the characteristics and risk profile of patients receiving PEPSE to determine whether this could inform development of pre-exposure prophylaxis (PrEP) policy for men who have sex with men (MSM). Methods Data from the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) were used to investigate the characteristics of patients receiving PEPSE. Associations with PEPSE use were assessed using multivariate logistic regression. Results Between 2011 and 2013, 14,118 patients received PEPSE, of which 63% (8,896) were MSM. Among MSM receiving PEPSE, 14% (1,213) received more than one course (maximum 13 courses), 45% (3,990) were aged 25–34 years and 75% (6,702) were of white ethnicity. 2.0% were diagnosed with HIV between 4 and 16 months after receiving their last course of PEPSE. Compared to MSM controls not receiving PEPSE, MSM receiving PEPSE were significantly more likely to be of non-white ethnicity (adjusted OR = 1.28, 95% CI 1.21–1.36), and to be diagnosed with HIV following a subsequent exposure (adjusted OR = 1.21, 95% CI 1.03–1.41). Discussion/conclusion MSM prescribed PEPSE are at high risk of acquiring HIV infection following a subsequent exposure and may require intensive interventions to ensure course completion and reduce HIV risk behaviour. PrEP may be beneficial for high-risk MSM receiving PEPSE and also avoid the need for repeat PEPSE prescriptions.