Amsterdam 2015
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| Abstract #2281 - PrEP | ||||
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Session: 50.5: PrEP (Symposium) on Friday @ 11.00-12.30 in C103 Chaired by John de Wit, Veronica Noseda Authors: Presenting Author: Dr Marie Suzan-Monti - INSERM UMR912 - SESSTIM, France |
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| Additional Authors: | ||||
| Aim: France’s HIV epidemic is concentrated in high-risk groups including men who have sex with men (MSM). The only efficacy trial in MSM to date (Iprex) prescribing daily oral pre-exposure prophylaxis (PrEP), showed a moderate reduction of HIV incidence, probably because of low adherence. Initial results from the “on-demand” oral PrEP with TDF-FTC ANRS Ipergay trial show an 86% (95% CI: 40-99) reduction in HIV-incidence among at-risk MSM1. The present analysis aimed to evaluate i) participants’ adherence to prescribed intermittent oral PrEP and/or condom use during sexual intercourse and ii) sexual behavior evolution over 24 months of follow-up. | ||||
| Method / Issue: ANRS Ipergay is a randomized double-blind trial including intermittent oral PrEP in high-risk MSM, randomly assigned to the trial’s TDF-FTC or placebo arms. For each sexual encounter, the protocol prescribed 2 pills of TDF-FTC (or placebo) between 2 and 24 hours before sex, and a third and fourth pill 24 and 48 hours after first drug intake, respectively. Participants received risk-reduction counselling and condoms. They were regularly tested for HIV and other sexually transmitted infections. Every 2 months they completed online questionnaires which collected sexual behavior and PrEP adherence data about their last sexual encounter. Three PrEP use categories were defined: correct, suboptimal (any PrEP use not following protocol) no PrEP. Sexual behavior over 24 months was assessed using 2-monthly data, by the median number of sexual encounters (previous 4 weeks), and of sexual partners (previous 2 months), and the frequency (over 24 months) of anal intercourse (AI) and receptive AI (RAI) without condoms during last sexual encounters. Differences were tested using a mixed model accounting for multiple measures over time. | ||||
| Results / Comments: Among 400 MSM enrolled, 396 (198 TDF-FTC, 198 placebo) completed 2478 questionnaires considered here (M0 to M24). Irrespective of sexual partner and practice type, in median(range), 44.1%(34-51%) and 41%(28-47%) of MSM enrolled in the TDF-FTC vs placebo arms reported PrEP use, respectively 28.5%(20-42%) and 30%(26-36%) reported PrEP and condom use 9.7%(4-15%) and 13.7%(10-19%) reported condom use only, and 17.7%(4-29%) and 15.4%(7-30%) reported no PrEP or condom use. Among those reporting PrEP use, 56.7%(43-69%) and 62.1%(53-78%) in the TDF-FTC and placebo arms, respectively, used PrEP correctly, while 43.3%(31-65%) and 37.9%(22-47%) used it suboptimally. From M0 to M24, 72.3%(65-81%) and 68.8%(59-74%) of MSM enrolled in TDF-FTC and placebo arms, respectively, reported condomless AI during their most recent sexual encounter, while 72.5%(66-79%) and 66.6%(47-74%) reported condomless RAI. Over time, a slight but significant decrease in the number of sexual partners during the previous 2 months was reported in the placebo arm (placebo median[IIQ]=7.5[320] TDF-FTC 8[415], p=0.001). From M0 to M24 however, no significant difference was observed between both arms in the total number of sexual encounters in the previous 4 weeks (placebo 10[418]) TDF-FTC 10[516], p=0.07). | ||||
| Discussion: A majority of high-risk MSM protected themselves during sexual intercourse using one of the prevention tools in the ANRS Ipergay trial while no sexual behavior disinhibition was observed. On demand PrEP included in comprehensive HIV services for MSM could improve prevention in this population. | ||||
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