Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago
Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago
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DOI：
10.1097/qad.0000000000001710
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发表时间：
2018-01-28
期刊：
影响因子：
3.8
通讯作者：
Schneider, John A.
中科院分区：
文献类型：
--
作者：
Lancki, Nicola;Almirol, Ellen;Schneider, John A.
背景：识别感染艾滋病毒风险最大的客户对于实施暴露前预防（PrEP）至关重要。青年黑人男男性接触者（YBMSM）是HIV感染的高发人群。我们研究了已发表的指南，以确定合格的PrEP候选人，包括血清转化者，在YBMSM的代表性队列中。方法：uConnect队列包括2013年和2016年在芝加哥推出PrEP期间16-29岁的YBMSM。使用疾病控制和预防中心（CDC）指南、MSM的HIV发病风险指数（HIRI-MSM）评分工具和吉利德的建议，计算18个月内HIV血清转换的灵敏度、特异性和曲线下面积（AUC），确定具有PrEP适应症的YBMSM。发病率比（IRR）使用泊松回归模型比较个人和网络因素与seroconversion.Results：在研究队列中，300 HIV未感染的YBMSM贡献了390.4人年的后续[平均年龄（SD），22.3岁（3.07）]。艾滋病毒感染率为8.5例/100人-年（95%置信区间，6.0-11.9）。一个网络因素与血清转换相关：伴侣年龄大于10岁（IRR = 4.4，95%置信区间，1.6-11.8）。总体而言，49%的队列有使用CDC指南的PrEP适应症; 72%使用HIRI-MSM，86%使用吉利德建议。HIV血清转换者（n = 33）在血清转换前被确定为符合PrEP条件，CDC（52%/0.51）、HIRI-MSM（85%/0.57）和吉利德指南（94%/0.54）的灵敏度/AUC。结论：CDC指南的灵敏度低，HIRI-MSM和吉利德筛查工具的AUC有限，这是在YBMSM等最高风险人群中实施PrEP的问题。考虑人口统计学、当地流行病学和网络因素可能会更好地指导识别最能从PrEP中受益的客户。版权所有（C）2018威科医疗集团。All rights reserved.
Background: Identification of clients at greatest risk of acquiring HIV is critical for preexposure prophylaxi (PrEP) implementation. Young black MSM (YBMSM) have high incidence of HIV. We examined published guidelines in identifying eligible PrEP candidates, including seroconverters, in a representative cohort of YBMSM.Methods: The uConnect cohort included YBMSM aged 16-29 years during PrEP roll-out in Chicago from 2013 and 2016. YBMSM with indications for PrEP were determined using Center for Disease Control and Prevention (CDC) guidelines, the HIV incidence risk index for MSM (HIRI-MSM) scoring tool, and Gilead recommendations with calculation of sensitivities, specificities, and area under the curve (AUC) for HIV seroconversion over 18 months. Incidence rate ratios (IRRs) using Poisson regression were modeled to compare individual and network factors associated with seroconversion.Results: In the study cohort, 300 HIV uninfected YBMSM contributed 390.4 person-years of follow-up [mean age (SD), 22.3 years (3.07)]. HIV incidence was 8.5 cases per 100 person-years (95% confidence interval, 6.0-11.9). One network factor was associated with seroconversion: having partners more than 10 years older (IRR = 4.4, 95% confidence interval, 1.6-11.8). Overall, 49% of the cohort had an indication for PrEP using CDC guidelines; 72% using HIRI-MSM, and 86% using Gilead recommendations. HIV seroconverters (n = 33) were identified as PrEP eligible prior to seroconversion with sensitivities/AUCs for CDC (52%/0.51), HIRI-MSM (85%/0.57), and Gilead guidelines (94%/0.54).Conclusion: Low sensitivity of CDC guidelines and limited AUC of HIRI-MSM and Gilead screening tools are of concern for PrEP implementation among most at risk populations such as YBMSM. Consideration of demographics, local epidemiology, and network factors may better guide identification of clients who could benefit most from PrEP. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.