prevention

PrEP Eligibility Criteria May Predict STI Diagnoses

Of the 6 eligibility criteria the US Centers for Disease Control and Prevention has set for pre-exposure prophylaxis (PrEP) therapy, 4 can predict sexually transmitted infections (STIs) diagnoses, according to a new study.

 

Through data from their Australian PreEPX trial, the researchers found that individuals who fulfill the 4 criteria have a significantly higher risk of having certain STIs than those who do not fulfill the criteria.

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“Our findings support the use of PrEP eligibility criteria recommended in current guidelines,” the researchers wrote.

 

To reach this conclusion, the researchers analyzed data on 1774 participants who enrolled in the trial between July 26, 2016, and December 23, 2016.

 

Participants were eligible to enroll in PrEPX if they had no medical contraindications to PrEP use, if they self-reported behavioral risk of HIV in the preceding 3 months, and if they foresaw an ongoing risk of HIV over the upcoming 3 months. Being at risk for HIV was defined as fulfilling 1 of the 6 eligibility criteria.

 

In all, 10.2% of the participants tested positive for STIs, namely syphilis, anorectal chlamydia, or anorectal gonorrhea.

 

The first 4 eligibility criteria predicted STI diagnoses with adjusted odds ratios of:

  • 2.5 for condomless anal intercourse with an HIV-positive regular sexual partner with detectable viral load,
  • 1.8 for for receptive condomless anal intercourse with casual sexual partners,
  • 1.8 for previous STIS, and
  • 2.1 for methamphetamine use.

 

The 5th (unsuccessful condom use) and 6th (insertive condomless anal intercourse when uncircumcised) eligibility criteria had adjusted odds ratios of 0.8 and 1.0, respectively, and so were deemed to not predict diagnoses of STIs.

           

Participants who fulfilled no eligibility criteria could be enrolled if clinically assessed to need PrEP. Of those participants, 7.1% had STIs.

 

“Participants enrolled outside the eligibility criteria had substantial prevalence of STIs, suggesting that people who request PrEP but do not fulfill eligibility criteria may nonetheless need PrEP,” the researchers concluded.

 

—Colleen Murphy

 

Reference:

Cornelisse VJ, Fairley CK, Stoove M, et al; for the PrEPX Study Team. Evaluation of preexposure (PrEP) eligibility criteria, using sexually transmissible infections as markers of human immunodeficiency virus (HIV) risk at enrollment in PrEPX, a large Australian HIV PrEP trial. Clin Infect Dis. 2018;67(12):1847-1852. https://doi.org/10.1093/cid/ciy370.