Tassi Marc-Florent, Laurent Emeline, Gras Guillaume, Lot Florence, Barin Francis, de Gage Sophie Billioti, Stefic Karl, Grammatico-Guillon Leslie
INSERM U1259, Université de Tours, France.
EA7505, Education Ethique et Santé, Université de Tours, France.
J Antimicrob Chemother. 2021 Oct 11;76(11):3002-3008. doi: 10.1093/jac/dkab263.
Clinical trials have demonstrated that oral pre-exposure prophylaxis (PrEP) has high efficacy in preventing HIV transmission. In many countries, HIV testing is recommended prior to PrEP initiation, 1 month after and quarterly thereafter. We assessed the uptake of HIV testing and estimated the incidence of HIV infections after oral PrEP initiation, by using the French national health database (SNDS).
A historic cohort study included every adult person who started oral PrEP between 1 January 2016 and 30 June 2018 in France. HIV infection was tracked in the follow-up, from first PrEP dispensation up to 31 December 2018. Factors associated with adherence to HIV testing in PrEP follow-up were analysed using a generalized linear mixed model.
PrEP users (9893) were followed for a median duration of 551 days (IQR 350-769). The first HIV test, 1 month after PrEP initiation, was performed by 64% of users. For subsequent tests, this rate exceeded 81% and remained stable over time. HIV testing was lower among PrEP users without prescription refill (OR 0.15; 99% CI 0.12-0.20), but higher if the last prescription was made by a hospital practitioner (OR 2.03; 99% CI 1.69-2.45). Twenty-nine HIV infections were identified, leading to an incidence of 0.19 cases per 100 person-years (99% CI 0.12-0.30).
We confirmed good adherence to HIV testing and efficacy of PrEP in users, which should help in decreasing HIV incidence in France. This study also revealed that SNDS could be a powerful automated tool for the epidemiological monitoring of PrEP users.
临床试验表明，口服暴露前预防（PrEP）在预防HIV传播方面具有很高的疗效。在许多国家，建议在开始PrEP之前、开始后1个月以及之后每季度进行HIV检测。我们通过使用法国国家卫生数据库（SNDS）评估了HIV检测的接受情况，并估计了开始口服PrEP后HIV感染的发生率。
一项历史性队列研究纳入了2016年1月1日至2018年6月30日期间在法国开始口服PrEP的每一位成年人。在随访中跟踪HIV感染情况，从首次发放PrEP到2018年12月31日。使用广义线性混合模型分析PrEP随访中与坚持HIV检测相关的因素。
对9893名PrEP使用者进行了中位时长为551天（四分位间距350 - 769天）的随访。64%的使用者在开始PrEP后1个月进行了首次HIV检测。对于后续检测，这一比例超过81%，且随时间保持稳定。没有处方续期的PrEP使用者中HIV检测率较低（比值比0.15；99%置信区间0.12 - 0.20），但如果最后一张处方是由医院从业者开具的，则检测率较高（比值比2.03；99%置信区间1.69 - 2.45）。共确定了29例HIV感染，导致每100人年的发病率为0.19例（99%置信区间0.12 - 0.30）。
我们证实了使用者对HIV检测的良好依从性以及PrEP的疗效，这应有助于降低法国的HIV发病率。这项研究还表明，SNDS可能是对PrEP使用者进行流行病学监测的有力自动化工具。
