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.
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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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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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.
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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.
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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 51, 2603–2611 (2022). https://doi.org/10.1007/s10508-021-02112-7
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DOI: https://doi.org/10.1007/s10508-021-02112-7