Missed opportunities of HIV pre-exposure prophylaxis in France: a retrospective analysis in the French DAT’AIDS cohort

BMC Infectious Diseases

the DAT’AIDS STUDY GROUP¹  V. Obry-Roguet²  C. Lions²  I. Poizot-Martin²  C. Duvivier³  A. Makinson⁴  B. Bonnet⁵  T. Huleux⁶  A. Cheret⁷  L. Hocqueloux⁸  L. Hustache-Mathieu⁹  O. Cabras^1,10  C. Jacomet^1,11  A. Cabié^1,12  E. Cua^1,13  L. Cotte^1,14  A. Gagneux-Brugnon^1,15 

[1] ;APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University;APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’infectiologie Necker-Pasteur;Infectious and Tropical Diseases Department, University Hospital Montpellier;Maladies Infectieuses et tropicales, CHU HOTEL DIEU;Service Universitaire des maladies infectieuses et du voyageur, CH Tourcoing;Service de Médecine Interne, CHU Kremlin Bicêtre, AP-HP;Service des maladies infectieuses et tropicales, CHR d’Orléans –La Source;Service des maladies infectieuses et tropicales, CHU Besançon;Service des maladies infectieuses et tropicales, CHU Bichat;Service des maladies infectieuses et tropicales, CHU Clermont Ferrand;Service des maladies infectieuses et tropicales, CHU de Martinique, INSERM CIC 1425 and Université des Antilles EA 4537;Service des maladies infectieuses et tropicales, CHU de Nice;Service des maladies infectieuses et tropicales, Hospices Civils de Lyon;Service d’Infectiologie, CHU Sainte-Etienne, Groupe Immunité des Muqueuses et Agents Pathogènes, Institut Presage, Université de Lyon;

关键词: Pre-exposure prophylaxis;    PrEP;    HIV;    Missed opportunities;    HIV testing;   

DOI  :  10.1186/s12879-019-3915-5

来源: DOAJ

【 摘 要 】

Abstract Background HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat’AIDS cohort in 2016. Methods Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. Results Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). Conclusion With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.

【 授权许可】

Unknown