Young men who have sex with men (YMSM) experience disparities in HIV acquisition more than any other group. Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine has been shown to effectively prevent HIV transmission in YMSM; however, recent studies suggest that young Black men who have sex with men experience subprotective levels of tenofovir diphosphate more frequently than other groups.
Combined data from Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 110/113, 2 open-label PrEP studies that provided PrEP and evidence-based behavioral interventions to YMSM aged 15–22 years.
Bivariate and logistic regression analyses were used to examine sociodemographic and behavioral factors associated with protective tenofovir diphosphate levels (defined as ≥700 fmol/punch) in ATN 110/113 data.
In bivariate analysis, self-identified Black participants, residential displacement due to sexual orientation, low perceived risk, and stigma with the medication were associated with subprotective levels. Hispanic ethnicity was associated with protective levels. In the final models, Black males were less likely to have subprotective levels than non-Black males at 4, 8, and 12 weeks. Self-reported displacement due to sexual orientation was associated with subprotective levels, whereas older age was as associated with protective levels.
These findings highlight how future behavioral research and biomedical prevention efforts in YMSM will need to address PrEP disparities that may occur in young Black men who have sex with men, perception of risk, and lack of key supportive housing during this period that may be critical factors that contribute to HIV acquisition.
*Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD;
†Department of Epidemiology, UAB School of Public Health, Birmingham, AL;
‡Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL;
§Division of Child and Adolescent Psychiatry, Statistician II, The University of Alabama at Birmingham, Birmingham, AL; and
║Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL.
Correspondence to: Renata Arrington-Sanders, MD, MPH, ScM, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Room 2063, Baltimore, MD 21287 (e-mail: firstname.lastname@example.org).
Supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health (U01 HD040533 and U01 HD040474) through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (B. Kapogiannis and S. Lee), with supplemental funding from the National Institute on Drug Abuse (K. Davenny and S. Kahana) and the National Institute of Mental Health (P. Brouwers and S. Allison). Study drug was donated by Gilead Sciences.
The authors have no funding or conflicts of interest to disclose. The study was scientifically reviewed by the ATN's Community Prevention Leadership Group. Network, scientific, and logistical support was provided by the ATN Coordinating Center (C. Wilson and C. Partlow) at The University of Alabama at Birmingham. Network operations and data management support was provided by the ATN Data and Operations Center at Westat (J. Korelitz and B. Driver). Network operations and data management support were provided by the ATN Data and Operations Center at Westat, Inc. (J. Korelitz and B. Driver). The authors acknowledge the contribution of the investigators and staff at the following sites that participated in the study: University of South Florida, Tampa (Emmanuel and Straub), Children's Hospital of Los Angeles (Belzer and Tucker), Children's Hospital of Philadelphia (Douglas, Tanney, and DiBenedetto), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Bojan, and Jackson), Tulane University Health Sciences Center (Abdalian, Kozina, and Baker), University of Miami School of Medicine (Friedman, Maturo, and Major-Wilson), St. Jude's Children's Research Hospital (Flynn, Gaur, and Dillard), Baylor College of Medicine (Paul, Calles, and Cooper), Wayne State University (Secord, Cromer, and Green-Jones), John Hopkins University School of Medicine (Agwu, Anderson, and Park), The Fenway Institute—Boston (Mayer, George, and Dormitzer), and University of Colorado Denver (McFarland, Reirden, and Hahn). Drug concentrations were assayed at the Colorado Antiviral Pharmacology Laboratory (Lane Bushman, Jia-Hua Zheng, L Anthony Guida, Becky Kerr, and Brandon Klein).
Received June 10, 2018
Accepted September 03, 2018