Skip to main content

HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence, Adverse Events, Sexual Behavior, and Sexually Transmitted Infections

Abstract

Tenofovir/emtricitabine (TDF/FTC) has been used as pre-exposure prophylaxis (PrEP) in preventing HIV infection. PrEP is an effective prevention tool as demonstrated in clinical trials and studies in clinical practice and was incorporated into the Brazilian public health system in December 2017. The present study was a prospective cohort that included 219 PrEP users monitored over a 10 month follow-up period in a capital city in Northeastern Brazil. Data were collected from the PrEP users’ electronic medical records platform made available by the Brazilian Health Ministry. During the observation period, there was good user retention to the prevention program (84%) and there was high adherence to medication (90%). Almost half the users (49%) presented an adverse event, although these were mild and transient, 30 days after starting prophylaxis. There was a significant reduction in creatinine clearance (p < .001), from 104.9 to 83.5 mL/min; however, there was no need for drug discontinuation. Throughout the cohort, there was no significant change in the number of sexual partners, but the use of condoms during sexual intercourse decreased (p < .001). There was a non-significant increase in the incidence of syphilis (p = .08), and there was a 50% decrease in reporting signs and symptoms of sexually transmitted infections. No cases of HIV infection were observed. PrEP proved to be an effective tool in HIV prevention, presenting few complications of adverse events.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  • Ascher, S. B., Scherzer, R., Estrella, M. M., Shigenaga, J., Spaulding, K. A., Glidden, D. V., & Jotwani, V. (2020). HIV preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and changes in kidney function and tubular health. AIDS, 34(5), 699–706.

    Article  Google Scholar 

  • Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., & Celum, C. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. New England Journal of Medicine, 367(5), 399–410.

    Article  Google Scholar 

  • Brasil. Ministério da Saúde. (2019a). Boletim Epidemiológico HIV / Aids | 2019. Available from: http://www.aids.gov.br/pt-br/pub/2019/boletim-epidemiologico-de-hivaids-2019

  • Brasil. Ministério da Saúde. (2019b). Boletim Epidemiológico de Sífilis. Ano V n-1:43. Available from: www.aids.gov.br

  • Brasil. Ministério da Saúde. (2020). Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Trasmissíveis. Available from: http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes

  • Cassell, M. M., Halperin, D. T., Shelton, J. D., & Stanton, D. (2006). Hiv and risk behaviour: Risk compensation: The Achilles’ heel of innovations in HIV prevention? British Medical Journal, 332(7541), 605–607.

    Article  Google Scholar 

  • Choopanya, K., Martin, M., Suntharasamai, P., Sangkum, U., Mock, P. A., Leethochawalit, M., & Vanichseni, S. (2013). Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (The Bangkok Tenofovir Study): A randomised, double-blind, placebo-controlled phase 3 trial. The Lancet, 381(9883), 2083–2090.

    Article  Google Scholar 

  • Elliott, T., Sanders, E. J., Doherty, M., & Ndung’u, T., Cohen, M., Patel, P., ... Fidler, S. (2019). Challenges of HIV diagnosis and management in the context of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), test and start and acute HIV infection: A scoping review. Journal of the International AIDS Society, 22(12), 25419. https://doi.org/10.1002/jia2.25419

  • Fonner, V. A., Dalglish, S. L., Kennedy, C. E., Baggaley, R., O’Reilly, K. R., Koechlin, F. M., & Grant, R. M. (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS, 30(12), 1973–1983.

    Article  Google Scholar 

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., & Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599.

    Article  Google Scholar 

  • Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., & Glidden, D. V. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. Lancet Infectious Diseases, 14(9), 820–829.

    Article  Google Scholar 

  • Greenwald, Z. R., Maheu-Giroux, M., Szabo, J., Robin, J. A. B., Boissonnault, M., Nguyen, V. K., & Thomas, R. (2019). Cohort profile: L’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada. BMJ Open, 9(6), 1–10. https://doi.org/10.1136/bmjopen-2018-028768

    Article  Google Scholar 

  • Grinsztejn, B., Hoagland, B., Moreira, R. I., Kallas, E. G., Madruga, J. V., Goulart, S., & Veloso, V. G. (2018). Retention, engagement prophylaxis and adherence to pre-exposure for men who have sex with men and transgender women in PrEP Brasil: 48 week results for a demonstration study. The Lancet HIV, 5(3), e136–e145.

    Article  Google Scholar 

  • Hoagland, B., Torres, T. S., Bezerra, D. R. B., Geraldo, K., Pimenta, C., Veloso, V. G., & Grinsztejn, B. (2020). Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil. Brazilian Journal of Infectious Diseases, 24(4), 360–364.

    Article  Google Scholar 

  • Hoornenborg, E., Coyer, L., Achterbergh, R. C. A., Matser, A., van der Loeff, M. F. S., Boyd, A., & de Vries, H. J. C. (2019). Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study. The Lancet HIV, 6(7), e447–e455.

    Article  Google Scholar 

  • Hosek, S. G., Rudy, B., Landovitz, R., Kapogiannis, B., Siberry, G., Rutledge, B., & Wilson, C. M. (2017). An HIV preexposure prophylaxis demonstration project and safety study for young MSM. Journal of Acquired Immune Deficiency Syndromes, 74(1), 21–29.

    Article  Google Scholar 

  • IBGE. (2010). Censo demográfico: 2010: educação e deslocamento: resultados da amostra. Available from: https://biblioteca.ibge.gov.br/index.php/biblioteca-catalogo?view=detalhes&id=7545

  • Marcus, J. L., Glidden, D. V., Mayer, K. H., Liu, A. Y., Buchbinder, S. P., Amico, K. R., & Grant, R. M. (2013). No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS ONE, 8(12), e81997.

    Article  Google Scholar 

  • McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., & Gill, O. N. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet, 387(10013), 53–60.

    Article  Google Scholar 

  • Montaño, M. A., Dombrowski, J. C., Dasgupta, S., Golden, M. R., Duerr, A., Manhart, L. E., & Khosropour, C. M. (2019). Changes in sexual behavior and STI diagnoses among MSM initiating PrEP in a clinic setting. AIDS and Behavior, 23(2), 548–555.

    Article  Google Scholar 

  • NIAAA. (2004). NIAAA council approves definition of binge drinking. NIAAA Newsletter, Number 3. Available from: https://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf

  • Ong, J. J., Baggaley, R. C., Wi, T. E., Tucker, J. D., Fu, H., Smith, M. K., ... Mayaud, P. (2019). Global epidemiologic characteristics of sexually transmitted infections among individuals using preexposure prophylaxis for the prevention of HIV infection: A systematic review and meta-analysis. JAMA Network Open, 2(12), e1917134.

  • Pilkington, V., Hill, A., Hughes, S., Nwokolo, N., & Pozniak, A. (2018). How safe is TDF/FTC as PrEP? A systematic review and meta-analysis of the risk of adverse events in 13 randomised trials of PrEP. Journal of Virus Eradication, 4(4), 215–224.

    Article  Google Scholar 

  • Scott, H. M., Spinelli, M., Vittinghoff, E., Morehead-Gee, A., Hirozawa, A., James, C., & Buchbinder, S. (2019). Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics. AIDS, 33(14), 2189–2195.

    Article  Google Scholar 

  • Solomon, M. M., Lama, J. R., Glidden, D. V., Mulligan, K., McMahan, V., Liu, A. Y., & Grant, R. M. (2014). Changes in renal function associated with oral emtricitabine/tenofovir disoproxil fumarate use for HIV pre-exposure prophylaxis. AIDS, 28(6), 851–859.

    Article  Google Scholar 

  • Thigpen, M. C., Kebaabetswe, P. M., Paxton, L. A., Smith, D. K., Rose, C. E., Segolodi, T. M., & Brooks, J. T. (2012). Antiretroviral Preexposure Prophylaxis for Heterosexual HIV Transmission in Botswana. New England Journal of Medicine, 367(5), 423–434.

    Article  Google Scholar 

  • Torres, T. S., Marins, L. M. S., Veloso, V. G., Grinsztejn, B., & Luz, P. M. (2019). How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis. BMC Infectious Diseases, 19(1), 1067. https://doi.org/10.1186/s12879-019-4704-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Traeger, M. W., Schroeder, S. E., Wright, E. J., Hellard, M. E., Fachshm, V. J. C., Doyle, J. S., & Stoové, M. A. (2018). Effects of Pre-exposure prophylaxis for the prevention of hiv infection on sexual risk behavior in men who have sex with men: A systematic review and meta-analysis author contact details. Clinical Infectious Diseases, 67(5), 676–686.

    Article  Google Scholar 

  • Volk, J. E., Marcus, J. L., Phengrasamy, T., Blechinger, D., Nguyen, D. P., Follansbee, S., & Hare, C. B. (2015). No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clinical Infectious Diseases, 61(10), 1601–1603.

    Article  Google Scholar 

  • Vuylsteke, B., Reyniers, T., de Baetselier, I., Nöstlinger, C., Crucitti, T., Buyze, J., Laga, & M. . (2019). Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence. Journal of the International AIDS Society, 22(10), e25407.

    Article  Google Scholar 

  • Zablotska, I. B., Vaccher, S. J., Bloch, M., Carr, A., Foster, R., Grulich, A. E., & Templeton, D. (2019). High Adherence to HIV Pre-exposure prophylaxis and No HIV seroconversions despite high levels of risk behaviour and STIs: The Australian demonstration study PrELUDE. AIDS and Behavior, 23(7), 1780–1789.

    Article  Google Scholar 

Download references

Acknowledgements

Hospital Universitário Oswaldo Cruz (HUOC), Programa de Pós-Graduação em Ciências da Saúde (PPGCS)–Universidade de Pernambuco, Equipe da PrEP do HUOC.

Funding

This study was financed in party by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance code 001.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Ana Karina Barbosa. Data analysis were performed by Ulisses Ramos Montarroyos. The first draft of the manuscript was written by Ana Karina Barbosa, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ana Karina Pinto Barbosa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was reviewed and approved by the Hospital Universitário Oswaldo Cruz Ethics Committee, Universidade de Pernambuco, in Recife-PE, Brasil (Protocol CAAE: 00995818.9.0000.1592). It was carried out respecting all ethical principles, in compliance with the Resolution 466/12 of the National Health Council.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barbosa, A.K.P., Monteiro, P., Montenegro, D. et al. HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence, Adverse Events, Sexual Behavior, and Sexually Transmitted Infections. Arch Sex Behav (2022). https://doi.org/10.1007/s10508-021-02112-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10508-021-02112-7

Keywords

  • Pre-exposure prophylaxis
  • HIV prevention
  • Sexual behavior
  • Sexually transmitted infections