A risk-assessment tool that incorporates more data on patient and partner behavior is more specific than are the CDC criteria for initiating HIV preexposure prophylaxis and would allow more targeted treatment, according to a report published in the January issue of Sexually Transmitted Diseases.
To construct a risk-assessment tool that incorporated the most relevant information for predicting HIV acquisition, researchers collected data for all the men who have sex with men who underwent serial HIV testing at a single Los Angeles facility during a 4-year period. These 9,481 men were HIV negative at their baseline visit and were followed for a mean of 2 years (range, from less than 1 year to more than 4 years) for seroconversion, said Matthew R. Beymer, PhD, of the Los Angeles LGBT Center and the University of California, Los Angeles, and his associates.
A total of 370 of these men acquired HIV infection during 16,894 person-years of follow-up.
The investigators constructed a risk-assessment tool to guide the initiation of PrEP, which included seven factors that were the most predictive of HIV seroconversion: Hispanic or African-American ethnicity; a self-reported history of chlamydia, gonorrhea, and/or syphilis; not using a condom during their last occasion of receptive anal sex; having more than three sexual partners during the preceding month or more than five during the preceding 3 months; being of the same ethnicity as the last sexual partner; experiencing intimate partner violence; and using methamphetamines or inhaled nitrates during the preceding year.
“If all individuals in our population who had a risk score of greater than or equal to 5 (51%) had been given PrEP [at baseline], 75% of HIV infections would [have been] averted during follow-up, assuming adequate regimen adherence and near complete effectiveness,” Dr. Beymer and his associates said (Sex Transm Dis. 2017;44[1]:49-57).
In contrast, CDC criteria would have selected 69% of this cohort to begin PrEP. The additional behavioral data incorporated into the risk-assessment tool “allowed for more targeted PrEP. Physicians, their patients, and other interested individuals can obtain their own personalized risk score by visiting www.IsPrEPforMe.org,” the investigators said.
They recommend that men with a risk score of 5 or higher on this instrument begin PrEP, and strongly recommend that men with a risk score of 8 or higher do so. “For individuals whose risk score is less than 5 but who request PrEP, we believe the provider should consider it in light of their patient’s overall concerns.”
Using this tool instead of CDC criteria permits a more personalized recommendation, the authors wrote. Also, those at risk will be better informed about what actions and circumstances specifically lead to their increased HIV risk, which can aid in deciding “to initiate PrEP, reduce sexual risk, or make a plan that incorporates both PrEP initiation and sexual risk reduction,” Dr. Beymer and his associates said.
The Center for HIV Identification, Prevention, and Treatment; the National Institute of Mental Health; and the UCLA Center for AIDS Research supported the study. Dr. Beymer and his associates reported having no relevant disclosures.