What are the characteristics of, and clinical outcomes in men who have sex with men prescribed HIV postexposure prophylaxis following sexual exposure (PEPSE) at sexual health clinics in England?

Abstract

MSM prescribed PEPSE are at high risk of subsequent HIV acquisition and our data show further risk stratification by clinical and PEPSE prescribing history is possible, which might inform clinical practice and HIV prevention initiatives in MSM.

An Update on the Global Epidemiology of Syphilis

“…Among men diagnosed with syphilis in London in 2013, there were up to 36 cases of syphilis (95% confidence interval: 34-38) per 100,000 men and 80% of those infected identified as MSM [148]; 40% of cases were found within 11 km of central London. During 2011 to 2014, MSM prescribed HIV post-exposure prophylaxis following sexual exposure had increased odds (adjusted odds ratio: 2.25 [95% confidence interval: 1.73-2.93]) of being diagnosed with syphilis in the last 12 months [149]. In 2011, among 2,704 women who identified as sex workers attending genitourinary medicine clinics in England 3 of 2,380 (0.1%) tested seropositive for syphilis, which was comparable to other non-sex worker female clinic attendees (285 of 466,248 [0.1%]) [150].…”

Data linkage to evaluate the long-term risk of HIV infection in individuals seeking post-exposure prophylaxis

“…This study investigated the long-term risk of HIV infection in individuals seeking PEP. In contrast to most previously published studies [4][5][6][7][8][9][10][11][12] , our study was larger and included a diverse PEP seekers population (heterogeneous transmission groups, i.e., inclusion of both MSM and heterosexuals), thereby ensuring wider applicability. We used data linkage to mitigate loss to follow-up bias and were able to collect outcome data that occurred-in some casesmore than 10 years after PEP consultation.…”

“…Whilst PEP intake in itself generally results in favorable outcome, some subgroups seem to remain at high risk for subsequent HIV infection 4,5 . To date, evidence on the long-term risk of HIV in PEP seekers remains limited and conflicting: HIV incidence after PEP intake was found to range from 0.78 to 7.6 per 100 person-years, but these findings were partly driven by small studies, conducted over short time periods (i.e., typically 6-12 months), and including exclusively MSM [4][5][6][7][8][9][10][11][12] . Although large cohort studies with prolonged follow-up are needed to better characterize populations with a higher long-term risk of HIV infection, loss to follow-up often undermines the feasibility of such studies.…”

Transitioning from HIV post‐exposure prophylaxis to pre‐exposure prophylaxis in men who have sex with men

“…HIV post‐exposure prophylaxis following sexual exposure (PEPSE) and pre‐exposure prophylaxis (PrEP) are used by people at sexual risk of HIV acquisition, including men who have sex with men (MSM) [1]. MSM who are prescribed PEPSE have a 2.5‐ to 5‐fold increase in HIV acquisition in the months after PEPSE compared with MSM not requiring PEPSE [2]. Owing to the high risk of HIV seroconversion due to ongoing risk behaviours, it is becoming commonplace for HIV‐negative MSM requiring PEPSE (e.g.…”