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HIV Seroconversion in the Era of Pharmacologic Prevention

A Case-Control Study at a San Francisco STD Clinic

Johnson, Kelly A. MD, MPH1; Hessol, Nancy A. MSPH1; Kohn, Robert MPH2; Nguyen, Trang Q. PhD, MPH2; Mara, Elise S. MPH2; Hsu, Ling MPH2; Scheer, Susan PhD, MPH2; Cohen, Stephanie E. MD, MPH2

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 27, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002107
Original Article: PDF Only
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Background: The comparative effectiveness of pre and post-exposure prophylaxis (PrEP and PEP) for men who have sex with men (MSM) is unclear.

Setting: We conducted a case-control study of MSM who were initially HIV-uninfected during 9/1/2012 – 6/30/2016 at San Francisco’s only municipal sexually transmitted diseases (STD) clinic.

Methods: Each case was matched with up to three controls based on age, baseline visit date, and follow-up time. The primary dependent variable was HIV seroconversion; the primary independent variable was exposure to PrEP, PEP, or neither. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals.

Results: Of 638 MSM (161 cases, 477 controls), 137 reported ever taking PrEP, 98 reported taking PEP only, and 403 took neither. PrEP takers had more non-HIV STDs during the analysis (72.3% vs. 55.1% vs. 42.4% p<0.01) and were more likely to report receptive anal sex in the last three months (86.5% vs. 80.4% vs. 73.0%; p<0.01). In the adjusted model, PrEP was associated with lower odds of HIV seroconversion (OR 0.24; 95% CI 0.13-0.46) while PEP use had no effect on HIV acquisition compared with taking neither.

Conclusions: MSM who ever used PrEP demonstrated equal or higher sexual risk compared to those using neither PrEP nor PEP but had 76% lower odds of HIV seroconversion. MSM who used PEP but never PrEP were no less likely to seroconvert than those using neither. MSM should be offered PrEP. PEP users with ongoing risk for HIV infection should be connected to PrEP after PEP.

1University of California, San Francisco

2San Francisco Department of Public Health

Corresponding author: Kelly A. Johnson, MD, MPH. UCSF Infectious Diseases; 513 Parnassus Ave., Rm S380, San Francisco CA, 94143. 415.476.9363 (phone); kjohnson@ucsf.edu.

Alternate corresponding author: Stephanie E. Cohen, MD, MPH. SF City Clinic; 356 7th Street, San Francisco CA, 94110. 415-487-5503 (phone); Stephanie.Cohen@sfdph.org.

Conflicts of Interest and Sources of Funding: This work was supported, in part, by the Centers for Disease Control and Prevention PS13-1302, [Grant number SU62PS004022-05], Core and Incidence HIV Surveillance. The authors have no conflicts of interest to disclose.

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