scholarly journals How to Identify Potential Candidates for HIV Pre-Exposure Prophylaxis: An AI Algorithm Reusing Real-World Hospital Data

2021 ◽  
Author(s):  
Jean-Charles Duthe ◽  
Guillaume Bouzille ◽  
Emmanuelle Sylvestre ◽  
Emmanuel Chazard ◽  
Cedric Arvieux ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Hiv Infections ◽  
University Hospital ◽  
Hospital Data ◽  
Sexual Health Care ◽  
Patients At Risk ◽  
Sex With Men ◽  
Exposure Prophylaxis

HIV Pre-Exposure Prophylaxis (PrEP) is effective in Men who have Sex with Men (MSM), and is reimbursed by the social security in France. Yet, PrEP is underused due to the difficulty to identify people at risk of HIV infection outside the “sexual health” care path. We developed and validated an automated algorithm that re-uses Electronic Health Record (EHR) data available in eHOP, the Clinical Data Warehouse of Rennes University Hospital (France). Using machine learning methods, we developed five models to predict incident HIV infections with 162 variables that might be exploited to predict HIV risk using EHR data. We divided patients aged 18 or more having at least one hospital admission between 2013 and 2019 in two groups: cases (patients with known HIV infection in the study period) and controls (patients without known HIV infection and no PrEP in the study period, but with at least one HIV risk factor). Among the 624,708 admissions, we selected 156 cases (incident HIV infection) and 761 controls. The best performing model for identifying incident HIV infections was the combined model (LASSO, Random Forest, and Generalized Linear Model): AUC = 0.88 (95% CI: 0.8143-0.9619), specificity = 0.887, and sensitivity = 0.733 using the test dataset. The algorithm seems to efficiently identify patients at risk of HIV infection.

scholarly journals Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Southern African HIV Clinicians Society Consensus Committee
Keyword(s):  
At Risk ◽  
Renal Function ◽  
Hiv Prevention ◽  
Hepatitis B ◽  
Hiv Infection ◽  
Creatinine Clearance ◽  
Fixed Dose ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

scholarly journals Medication Adherence Among Men Who Have Sex with Men at Risk for HIV Infection in the United States: Implications for Pre-Exposure Prophylaxis Implementation

2014 ◽  
Vol 28 (12) ◽  
pp. 622-627 ◽  
Author(s):  
Albert Y. Liu ◽  
Nancy A. Hessol ◽  
Eric Vittinghoff ◽  
K. Rivet Amico ◽  
Elizabeth Kroboth ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
Medication Adherence ◽  
Hiv Infection ◽  
The United States ◽  
Sex With Men ◽  
Exposure Prophylaxis

Renal impairment: an unnecessary barrier to HIV prevention

Sexual Health ◽  
2020 ◽  
Vol 17 (3) ◽  
pp. 299
Author(s):  
Jack E. Heron ◽  
Suzanne Rix ◽  
Rick Varma ◽  
David M. Gracey
Keyword(s):  
Chronic Kidney Disease ◽  
At Risk ◽  
Renal Impairment ◽  
Hiv Infection ◽  
Fanconi Syndrome ◽  
Moderate Renal Impairment ◽  
Regulatory Issues ◽  
Patients At Risk ◽  
Exposure Prophylaxis ◽  
Pharmaceutical Benefits Scheme

The use of tenofovir disoproxil fumarate (TDF) in combination with emtricitabine, prescribed for pre-exposure prophylaxis (PrEP), is highly effective at reducing incident sexually transmissible HIV infection among those at risk. TDF is associated with proteinuria, Fanconi syndrome and chronic kidney disease, and is not recommended for use in patients with an estimated creatinine clearance <60 mL min−1. There are currently no Pharmaceutical Benefits Scheme (PBS)-funded PrEP options for patients at risk of HIV infection with moderate renal impairment in Australia. This report describes the case of a patient who acquired HIV soon after PrEP was suspended due to moderate renal impairment. The various clinical and regulatory issues this case raises are discussed.

scholarly journals Pre-exposure prophylaxis makes it possible to better live one’s sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Marie Bistoquet ◽  
Alain Makinson ◽  
Vincent Tribout ◽  
Cyril Perrollaz ◽  
Gérard Bourrel ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Phenomenological Study ◽  
Family Doctor ◽  
Motivational Factors ◽  
Social Representation ◽  
University Hospital ◽  
Sexual Life ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is instrumental in the prevention of HIV for HIV-uninfected persons, by drastically reducing the risk of acquisition in the case of high-risk exposures. Despite its demonstrated efficacy, it remained under-prescribed in France until 2018. The principal aim of this study was to understand the motivations of Men who have Sex with Men (MSM) who started using PrEP in Montpellier, France. Methods A phenomenological study was undertaken, using semi-structured interviews with twelve participants attending the University Hospital of Montpellier for PrEP. Interviews were analysed by means of triangulation up to the point of theoretical saturation, using a semio-pragmatic method. Results Fear of HIV infection, personalised regular follow-up, and the wish to take care of one’s health were the primary motivational factors. PrEP allows for a better sexual life restoring a sense of freedom despite the risks of STI, deemed manageable by PrEPers. PrEP does not modify long-term risk-taking behaviours but helps them better live their own sexuality and guides them towards a responsible approach to sexuality. Unclear information on PrEP, delivered by their family doctor, public campaigns or the media, leads to misrepresentations or negative social representation, including within the MSM community, which may delay its implementation. Conclusions Fear of HIV infection and the benefits of regular medical follow-up to take care of one’s health were motivational factors of importance for the use of PrEP by MSM in this study. PrEP transforms all existential dimensions of their lived experience, improving sexual identity and happiness. There is a need to improve professional awareness of the effectiveness of PrEP and to develop a patient centered approach, to disseminate information more widely to the general public and among MSM to reduce stigmatisation.

scholarly journals Use of multiple recreational drugs is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiang Mao ◽  
Sequoia I. Leuba ◽  
Qinghai Hu ◽  
Hongjing Yan ◽  
Zhe Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Risk Behaviors ◽  
Sexual Behaviors ◽  
Hiv Infections ◽  
Recreational Drugs ◽  
Limited Information ◽  
High Risk Behaviors ◽  
Sex With Men ◽  
Recent Hiv Infection

Abstract Background There is limited information about the types of recreational drugs used by men who have sex with men (MSM) in China or the consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition. Methods We recruited MSM from seven cities in China between 2012 and 2013 using multiple approaches including advertisements on gay websites, collaborating with local MSM community-based organizations, peer referrals, and venues such as gay bars and bathrooms visited by MSM. We divided participants into four subgroups based on the number of recreational drugs (RDs) used in the previous 6 months. We defined use of multiple RDs as use of ≥2 types of RDs. Demographics and HIV-related high-risk behaviors were collected, and blood samples were tested for recent HIV infection by the HIV-1 subtypes B, E, and D immunoglobulin G capture enzyme immunoassay (BED-CEIA). We used multivariable logistic regression adjusted for sociodemographics to determine the adjusted odds ratios (aORs) and associated 95% confidence intervals (CIs) of the subgroups of RD use for recent or established HIV infection. Results A total of 4496 Chinese MSM participated; 28.4% used RDs, and 5% used multiple types of RDs. The prevalence of each RD use was as follows: poppers (25.9%), ecstasy (2.4%), ketamine (1.2%), amphetamine (0.6%), tramadol (0.4%), methamphetamine (3.8%), and codeine (1.9%). Users of multiple RDs commonly used poppers combined with one or more other types of RDs. Multiple RD users were likely to be aged 26–30 years (vs. 18–25 and > 30 years), live in non-local cities (vs. local cities), never married (vs. married), have a high monthly income (vs. no income and 1–599 USD), use versatile positions during anal intercourse (vs. top or bottom), and have inadequate HIV-related prevention knowledge (vs. adequate). As the number of RDs used in the previous 6 months increased, the prevalence of HIV-related high-risk behaviors increased (P < 0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95% CI: 1.5–3.0) or two types of RD (aOR=2.3, 95% CI: 1.0-5.2) in the previous 6 months compared to the odds among those who did not use RDs. Conclusion The level and pattern of multiple RD use among Chinese MSM were different from high-income countries. MSM who used more RDs are more likely to engage in high-risk sexual behaviors, and these behaviors may be associated with increases in new HIV infections.

The role of bronchoscopy in the diagnosis of pulmonary tuberculosis in patients at risk for HIV infection

1993 ◽  
Vol 16 (1) ◽  
pp. 41
Author(s):  
Nancy Shields ◽  
S. H. Salzman ◽  
M. L. Schindel ◽  
C. P. Aranda ◽  
R. L. Smith ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Tuberculosis ◽  
Hiv Infection ◽  
Patients At Risk

An outbreak of syphilis in Oslo

2002 ◽  
Vol 13 (6) ◽  
pp. 370-372 ◽  
Author(s):  
A M Halsos ◽  
K Edgardh
Keyword(s):  
Public Health ◽  
Hiv Infection ◽  
Medical Records ◽  
University Hospital ◽  
Oral Sex ◽  
Sexual Contacts ◽  
Male Patients ◽  
Sex With Men ◽  
Latent Syphilis ◽  
Retrospective Investigation

During 1999 and 2000, an outbreak of syphilis occurred in Norway: 93 cases were reported to the National Institute of Public Health. This report summarizes a retrospective investigation of the medical records of 60 patients with primary, secondary and early latent syphilis treated during 1999–2000 at the Department of STD at the Ullevål University Hospital in Oslo. Five women and 55 men were treated, mean age 38.6 and 44.9 years, respectively. Of the 60 cases, 14 (23.3%) had primary, 39 (65.0) secondary and seven (11.7%) early latent syphilis. Men who have sex with men (MSM) constituted 78.2% (43/55) of the male patients. Transmission among MSM was related to casual sexual contacts in bathhouses in Oslo. Two cases occurred among men with previously diagnosed HIV infection. Two new cases of HIV were reported. Condom use was inconsistent, and seldom used for oral sex.

scholarly journals Exploring Gender Differences in PrEP Interest Among Individuals Testing HIV Negative in an Urban Emergency Department

2018 ◽  
Vol 30 (5) ◽  
pp. 382-392 ◽  
Author(s):  
Jessica Ridgway ◽  
Ellen Almirol ◽  
Jessica Schmitt ◽  
Alvie Bender ◽  
Grace Anderson ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Hiv Risk ◽  
Behavioral Risk ◽  
Self Perception ◽  
Subjective Risk ◽  
Sex With Men ◽  
Not At Risk ◽  
Urban Emergency Department ◽  
Hiv Negative

PrEP is greater than 90% effective at preventing HIV infection, but many people who are vulnerable to HIV choose not to take PrEP. Among women, men who have sex with women (MSW) and men who have sex with men (MSM) who tested HIV negative in our emergency department, we assessed behavioral risk factors, self-perception of HIV risk, and interest in PrEP linkage. Women had lower odds of perceiving any HIV risk versus no risk than MSM, while Whites had greater odds of perceiving themselves as high risk than Blacks. Age and self-perception of risk were not associated with PrEP interest, but patients who were objectively classified as “at risk” had greater odds of interest in PrEP than those not at risk (p < .01). Discordance between HIV risk self-perception and objective risk demonstrates the limitation of relying on patient self-referral for PrEP based on their own subjective risk perception.

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