SF’s great big PrEP study: no new HIV infections in four years. But… #HIV #AIDS #PrEP
More proof PrEP works. 1045 people enrolled in the study and absolutely no new HIV infections in the whole lot. This revelation has been all over the web and it should be, but here’s the part that nobody is making too much noise over: (taken from the article)
There were no HIV infections in anyone who initiated PrEP during the study period. However, 187 people (28.5%) were diagnosed with another STI during follow-up, 78 of them (12%) more than once. The annual incidence rate for any STI – i.e. the proportion of STIs diagnosed over the course of a year on PrEP, in those who took it for a year or more – was 50%. Annual incidence was 33% for rectal infections, 33% for chlamydia, 28% for gonorrhoea and 5.5% for syphilis.
More on this below. For the moment, here’s the good news:
A programme that provides pre-exposure prophylaxis (PrEP) through primary care referrals in San Francisco has not seen a single HIV infection in people using PrEP since it started in 2012.
This is despite high levels of sexually transmitted infections (STIs) other than HIV and, in about 40% of users, less use of condoms.In an editorial on the findings of the study, Kimberley Koester of UCSF and Bob Grant, principal investigator of the pioneering iPrEx PrEP study, comment that it is important to keep one’s eyes on the main prize – no new HIV infections – as “an expected and most desired outcome”.However, they note, it is also “Time for a vigorous conversation about sexually transmitted infections, too long eclipsed by fear of HIV infection.”
They suggest that PrEP may offer more opportunities both within clinics and within the community to discuss and test for other STIs.Kaiser Permanente is one of the USA’s largest healthcare providers, providing medical care to over nine million people nationwide and 170,000 adults within the city of San Francisco. The present study includes all Kaiser Permanente clients living in San Francisco who were evaluated for PrEP between July 2012, when the US Food and Drug Administration approved tenofovir/emtricitabine (Truvada) for PrEP until February 2015.
The Kaiser programme generally refers patients to a specialist PrEP programme through their primary care physician, at the patient’s request or physician’s suggestion. Patients are always screened for medical contra-indications and tested for HIV during referral. While taking PrEP they are tested for HIV and STIs at least quarterly (for some people as often as once a month).
In addition, since July 2014, patients have been sent a confidential questionnaire, six months after starting PrEP, about whether there have been any changes in their sexual behaviour.
During the study period, 1045 people were referred for PrEP. Of these 80% were evaluated for PrEP by specialist providers and 657 actually started PrEP (63% of those referred and 81% of those evaluated). Twenty individuals stopped and restarted PrEP in the study period – they were not classed as ‘initiators’ – and 144 individuals were evaluated but chose not to start PrEP.
Now, about those pesky STI’s. Nobody thought for a second that guys getting on PrEP would 100% of the time stick with their condoms too, myself included. Do I use them all the time? No, and I doubt that’ll change. Having been in two trials around PrEP, I can tell you right now that the information I obtained about STI’s was woefully inadequate. I know all about them, and my circle of buddies I get naked and play with is a near closed and carefully cultivated one, so my STI risks are near zero.
The same cannot be said for everybody. In the heat of passion – or just plain being horny – you’re not going to be that careful or discriminating. That being the case, you just might slut walk of shame away with something that you need a visit to the clinic to fix.
To be clear, this study did not run any control group to see if the guys on PrEP were more prone to getting STI’s. The conclusions were that just being on PrEP, and giving your condoms the heave ho is putting you at possible risk FOR STI’s and in quite a few people it’s happening.
If this is an OK trade off for you, well then, carry on. To some people it’s not, myself included. I’m 51 years old, and I get a staggering amount of naked play time for my age; far more than I ever did at 25 and this isn’t solely because I’m taking Truvada. I guard my sexual health like a porn star, and I always have. The number of STI’s I’ve gotten in my sexual lifetime? Zero.
Something to consider if you’re on PrEP and STI’s are an unacceptable cost of doing business.