Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW)

Nila J Dharan; Fengyi Jin; Stefanie Vaccher; Benjamin Bavinton; Barbara Yeung; Rebecca Guy; Andrew Carr; Iryna Zablotska; Janaki Amin; Philip Read; David J Templeton; Catriona Ooi; Sarah J Martin; Nathan Ryder; Don E Smith; Anna McNulty; Katherine Brown; Karen Price; Jo Holden; Andrew E Grulich; Expanded PrEP Implementation in Communities in New South Wales (EPIC-NSW) research group

doi:10.1093/cid/ciac660

Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW)

Clin Infect Dis. 2023 Feb 8;76(3):e622-e628. doi: 10.1093/cid/ciac660.

Authors

Nila J Dharan¹, Fengyi Jin¹, Stefanie Vaccher¹, Benjamin Bavinton¹, Barbara Yeung¹, Rebecca Guy¹, Andrew Carr^{2

3}, Iryna Zablotska^{4

5

6}, Janaki Amin⁷, Philip Read⁸, David J Templeton^{1

9

10}, Catriona Ooi^{11

12}, Sarah J Martin^{13

14}, Nathan Ryder^{1

15}, Don E Smith¹⁶, Anna McNulty¹⁷, Katherine Brown¹⁸, Karen Price¹⁹, Jo Holden²⁰, Andrew E Grulich¹; Expanded PrEP Implementation in Communities in New South Wales (EPIC-NSW) research group

Collaborators

Expanded PrEP Implementation in Communities in New South Wales (EPIC-NSW) research group:
Rebecca Guy, Jeff Jin, Janaki Amin, Nila J Dharan, Iryna Zabloska, Stefanie Vaccher, Mo Hammoud, Kerry Chant, Jo Holden, Christine Selvey, Bill Whittaker, Heather-Maire Schmidt, Dale Halliday, Cherie Power, Karen Price, Nicolas Parkhill, Andrew Carr, Anna McNulty, Ben Anderson, Brad Forssman, Catriona Ooi, Christopher Carmody, Daniel Chanisheff, David Baker, David Lewis, David Smith, David J Templeton, David Townsend, Debra Allen, Don E Smith, Eva Jackson, Emanuel Vlahakis, Gia Han Thai, Hugh MacLeod, Josephine Lusk, Katherine Brown, Kym Collins, Mark Bloch, Nathan Ryder, Nicolas Doong, Phillip Read, Robert Finlayson, Sarah J Martin, Clara Tuck Meng Soo, Barbara Yeung, Erin Ogilvie, Gesalit Cabrera, Shawn Clackett, Toby Vickers, Lucy Watchirs Smith

Affiliations

¹ Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.
² St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
³ University of New South Wales Sydney, Sydney, New South Wales, Australia.
⁴ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.
⁵ Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, New South Wales, Australia.
⁶ Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia.
⁷ Department Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia.
⁸ Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
⁹ Department of Sexual Health Medicine, Sydney Local Health District, Camperdown, New South Wales, Australia.
¹⁰ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹¹ Clinic 16, St Leonards, New South Wales, Australia.
¹² Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia.
¹³ Canberra Sexual Health Centre, Canberra Health Services, Woden, Australia Capital Territory, Australia.
¹⁴ The Australian National University Medical School, Canberra, Australia Capital Territory, Australia.
¹⁵ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
¹⁶ Albion Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
¹⁷ School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
¹⁸ Illawarra Sexual Health, Warrawong, New South Wales, Australia.
¹⁹ AIDS Council of New South Wales (ACON), Sydney, New South Wales, Australia.
²⁰ New South Wales Health, Sydney, New South Wales, Australia.

PMID: 35982613
DOI: 10.1093/cid/ciac660

Abstract

Background: Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia.

Methods: Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week.

Results: A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis.

Conclusions: Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness.

Keywords: HIV risk behaviors; HIV seroconversion; PrEP; adherence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anti-HIV Agents* / therapeutic use
Cohort Studies
HIV
HIV Infections* / diagnosis
HIV Infections* / epidemiology
HIV Infections* / prevention & control
HIV Seropositivity* / drug therapy
Homosexuality, Male
Humans
Male
Medication Adherence
Pre-Exposure Prophylaxis*
Prospective Studies
Seroconversion
Sexual and Gender Minorities*

Substances

Anti-HIV Agents