No abstract

Background: Routine HIV pre-exposure prophylaxis (PrEP) and HIV care appointments provide opportunities for screening men who have sex with men (MSM) for hepatitis C virus infection (HCV). However, levels of screening required for achieving the WHO elimination target of reducing HCV incidence by 90% by 2030 among all MSM are unknown. Methods: An HCV/HIV transmission model was calibrated to UK prevalence of HIV among MSM (4¢7%) and chronic HCV infection among HIV-positive MSM (9¢9%) and HIV-negative MSM (1.2%). Assuming 12¢5% coverage of PrEP among HIV-negative MSM, we evaluated the relative reduction in overall HCV incidence by 2030 (compared to 2018 levels) of HCV screening every 12/6-months (alongside completing direct acting antiviral treatment within 6-months of diagnosis) in PrEP users and/or HIV-diagnosed MSM. We estimated the additional screening required among HIV-negative non-PrEP users to reduce overall incidence by 90% by 2030. The effect of 50% reduction in condom use among PrEP users (risk compensation) was estimated. Results: Screening and treating PrEP users for HCV every 12 or 6-months decreases HCV incidence by 67¢3% (uncertainty range 52¢7À79¢2%) or 70¢2% (57¢1À80¢8%), respectively, increasing to 75¢4% (59¢0À88¢6%) or 78¢8% (63¢9À90¢4%) if HIV-diagnosed MSM are also screened at same frequencies. Risk compensation reduces these latter projections by <10%. To reduce HCV incidence by 90% by 2030 without risk compensation, HIVnegative non-PrEP users require screening every 5¢6 (3¢8À9¢2) years if MSM on PrEP and HIV-diagnosed MSM are screened every 6-months, shortening to 4¢4 (3¢1À6¢6) years with risk compensation. For 25¢0% PrEP coverage, the HCV elimination target can be reached without screening HIV-negative MSM not on PrEP, irrespective of risk compensation. Interpretation: At low PrEP coverage, increased screening of all MSM is required to achieve the WHO HCVelimination targets for MSM in the UK, whereas at higher PrEP coverage this is possible through just screening HIV-diagnosed MSM and PrEP users.

Objectives The aim of the study was to evaluate the efficacy of dual therapy with lamivudine (3TC), with dose adjustment for renal function, and dolutegravir (DTG) in a subgroup of patients fully suppressed on treatment who were switched because of concerns about comorbidity and toxicity on their current triple drug regimen. Methods A retrospective evaluation of clinical and pathological parameters from an electronic patient record from a single centre was carried out. Results There were no virological failures in 52 patients with a median age of 60.5 years. The median duration of follow‐on dual therapy was 2.29 years (28 months; range 1.10–3.34 years). In 25 of 52 (48%) cases, the dose of 3TC was adjusted taking into account reduced renal function, and none of these patients experienced virological failure. Four additional patients discontinued early, because of side effects of the switch, with no failure. Conclusions This retrospective review suggests that 3TC and DTG may be effective in controlling viral load in older patients with comorbidities. This regimen appears to be a useful option in the context of comorbidities (including renal impairment) and polypharmacy in older patients. However, this review has been conducted in one centre and in a small population of patients. Therefore, further multicentre trials involving larger populations of patients are needed.

A mixed methods study of cisgender men/transpersons who have sex with men sexual health clinic attendees found that preexposure prophylaxis reduced anxiety and may increase likelihood of condomless anal intercourse, but risk of sexually transmitted infection antimicrobial resistance was not seen as an immediate threat. Supplemental digital content is available in the text.