Wahome Elizabeth W, Graham Susan M, Thiong'o Alexander N, Mohamed Khamisi, Oduor Tony, Gichuru Evans, Mwambi John, Prins Prof Maria, van der Elst Elise, Sanders Prof Eduard J
KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.
Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Wash, USA.
EClinicalMedicine. 2020 Sep 9;26:100541. doi: 10.1016/j.eclinm.2020.100541. eCollection 2020 Sep.
Data on HIV-1 incidence following programmatic pre-exposure prophylaxis (PrEP) uptake by men who have sex with men (MSM) are limited in sub-Saharan Africa.
Since June 2017, MSM participating in an ongoing cohort study in Kenya were offered daily PrEP, assessed for PrEP uptake and adherence, and evaluated for HIV-1 acquisition monthly. We determined tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots 6-12 months after PrEP initiation, and tenofovir (TFV) concentrations and genotypic drug resistance in plasma samples when HIV-1 infection occurred. We assessed HIV-1 incidence by reported PrEP use.
Of 172 MSM, 170 (98·8%) were eligible for PrEP, 140 (82·4%) started it, and 64 (57·7%) reported PrEP use at end of study. Of nine MSM who acquired HIV-1 [incidence rate: 3·9 (95% confidence interval (CI), 2·0-7·4) per 100 person-years (PY)], five reported PrEP use at the time of HIV-1 acquisition [incidence rate: 3·6 (95% CI, 1·5-8·6) per 100 PY)] and four had stopped or had never started PrEP [incidence rate: 4·3 (95% CI, 1·6-11·3) per 100 PY]. Among 76 MSM who reported PrEP use, 11 (14·5%) had protective TFV-DP concentrations of ≥700 fmol/punch (≥4 tablets a week). Among the five MSM who acquired HIV-1 while reporting PrEP use, only one had detectable but low TFV concentrations in plasma and none had genotypic HIV-1 resistance.
HIV-1 incidence among MSM with access to programmatic PrEP was high and did not differ by reported PrEP use. Only one in seven MSM taking PrEP had protective tenofovir concentrations and four out of five MSM who acquired HIV-1 while reporting PrEP use had not taken it. Strengthened PrEP adherence support is required among MSM in Kenya.
This work was supported by the International AIDS Vaccine Initiative (IAVI).
在撒哈拉以南非洲地区，关于男男性行为者（MSM）接受方案性暴露前预防（PrEP）后的HIV-1发病率数据有限。
自2017年6月起，参与肯尼亚一项正在进行的队列研究的MSM被提供每日PrEP，评估PrEP的接受情况和依从性，并每月评估HIV-1感染情况。我们在PrEP开始6至12个月后测定干血斑中的替诺福韦二磷酸（TFV-DP）浓度，以及HIV-1感染发生时血浆样本中的替诺福韦（TFV）浓度和基因型耐药情况。我们根据报告的PrEP使用情况评估HIV-1发病率。
在172名MSM中，170名（98.8%）符合PrEP条件，140名（82.4%）开始使用PrEP，64名（57.7%）在研究结束时报告使用PrEP。在9名感染HIV-1的MSM中[发病率：每100人年（PY）3.9（95%置信区间（CI），2.0 - 7.4）]，5名在HIV-1感染时报告使用PrEP[发病率：每100 PY 3.6（95% CI，1.5 - 8.6）]，4名已停止或从未开始使用PrEP[发病率：每100 PY 4.3（95% CI，1.6 - 11.3）]。在76名报告使用PrEP的MSM中，11名（14.5%）的TFV-DP浓度具有保护性，≥700 fmol/打孔（每周≥4片）。在5名报告使用PrEP时感染HIV-1的MSM中，只有1名血浆中可检测到但TFV浓度较低，且均无HIV-1基因型耐药。
能够获得方案性PrEP的MSM中HIV-1发病率较高，且与报告的PrEP使用情况无关。服用PrEP的MSM中只有七分之一的人具有保护性替诺福韦浓度，五名报告使用PrEP时感染HIV-1的MSM中有四名未服用PrEP。肯尼亚的MSM需要加强PrEP依从性支持。
这项工作得到了国际艾滋病疫苗倡议（IAVI）的支持。
