An HIV clinic in Boston sees a 90% reduction in the number of infections in PrEP-prescribed people

Fenway is a community health center specializing in sexual and gender minorities. Its director, Dr. Ken Mayer, told the conference that, while randomized controlled trials have demonstrated globally that PrEP works, more surveillance studies were needed to show what is happening. actually HIV infections when PrEP is offered to a population of clinics.

The study cohort consisted of all individuals who had attended the clinic between the beginning of 2012 and the end of 2017 and who had undergone at least two HIV tests (to show that they were initially seronegative for HIV) during this period. People who received PrEP prescriptions at any time during this period were defined as "PrEP users" even though they only took it for three months.

During this period, 16,128 patients were tested more than once for HIV. Just over 60% were Caucasian, with the remaining percent being Asian, Hispanic or African American. We know that 15% are women, but in 24% of cases, sex was not recorded.

Of the 16,128 patients, 3,965 (just under 25%) started PrEP. PrEP users were much less likely to be women (1.4%) and somewhat less likely to be blacks (6% of PrEP users vs. 8% of nonusers) and under 25 (11% versus 13%).

Across the clinical population, 163 (1.34%) of those who have never received PrEP have been infected with HIV and 17 (0.43%) of PrEP users. This represents a 68% reduction in infections among people who have already received PrEP.

Of the 17 HIV-infected PrEP users (all homosexual / bisexual), nine (53%) had bacterial STI infection at the same time and one had acute hepatitis C. Seven were admitted to chemsex and four were infected with HIV. degree of drug resistance, including resistance to tenofovir (K65R).

However, 12 of the 17 PrEP recipients actually had no PrEP prescription at the time of infection, having discontinued it at least a month before. Of these 12 people, four said they stopped treatment due to compliance / planning difficulties, four had problems with insurance, three said they felt low risk and one said that he had stopped because of the stigma associated with PrEP.

The infection rate among current PrEP users was therefore 0.13%, indicating an efficacy of 90%.

Of these five, three almost certainly had an acute HIV infection when starting PrEP; it was found that a positive test for HIV RNA was detected the same day. A fourth admitted taking a month off PrEP at the time of infection.

The fifth stated that it "was missing only one day and the other" of PrEP, and could be a real failure of PrEP. He caught primary syphilis at the same time as HIV and had HIV resistance to emtricitabine, which could possibly indicate a major infection. This would be equivalent to 98% population effectiveness.

However, no measure of the level of drug has been performed in this patient. His medical record indicated some membership errors. He admitted he did not always take his PrEP with him on a business trip. This case therefore can not be counted among the handful of documented cases of PrEP failure. .