Open AccessPatterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care
Author(s) -
Krakower Douglas,
Maloney Kevin M,
Powell Victoria E,
Levine Ken,
Grasso Chris,
Melbourne Kathy,
Marcus Julia L,
Mayer Kenneth H
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25250
Subject(s) - medicine , human immunodeficiency virus (hiv) , proportional hazards model , ethnic group , primary care , demography , family medicine , sociology , anthropology
Discontinuations of HIV preexposure prophylaxis (Pr EP ) by at‐risk individuals could decrease the effectiveness of Pr EP . Our objective was to characterize patterns of, reasons for, and clinical outcomes associated with Pr EP discontinuations in primary care. Methods We conducted medical chart reviews for patients prescribed Pr EP during 2011 to 2014 at a Boston community health centre specializing in healthcare for sexual and gender minorities. Patients were followed through 2015. We characterized patients’ sociodemographics, relationship status, behavioural health conditions, patterns of and reasons for Pr EP discontinuations, and HIV seroconversions. Cox proportional hazards models were used to assess patient factors associated with Pr EP discontinuations. Results Of the 663 patients prescribed Pr EP , the median age was 33 years, 96% were men who have sex with men ( MSM ) and 73% were non‐Hispanic white; 40% were in committed relationships and 15% had HIV ‐infected partners. Patients either used Pr EP continuously (60%), had 1 or more discontinuations (36%), or did not initiate Pr EP (4%). Discontinuations were most often due to a decrease in HIV risk perception (33%), non‐adherence to care plans (16%), or insurance barriers (12%). Of the 7 (1.1%) Pr EP patients diagnosed with HIV , 1 was HIV ‐infected at baseline, 2 seroconverted while using Pr EP , and 4 seroconverted after discontinuations. In a multivariable model adjusted for race/ethnicity, relationship status, substance use disorders, and insurance status, those who were less than 30 years old ( aHR 2.0, 95% CI 1.4 to 2.9 for ages 18 to 24, aHR 2.2, 95% CI 1.6 to 3.1 for ages 25 to 29, vs. ages 30 to 39 years), who identified as transgender women ( aHR 2.0, 95% CI 1.2 to 3.4, vs. cisgender men), and who had mental health disorders ( aHR 1.2, 95% CI 1.1 to 1.4 for each additional disorder) were more likely to have discontinuations. Conclusions Discontinuations of Pr EP use among this American sample of predominately MSM were common, particularly among patients who were younger, identified as transgender women, or had behavioural health issues. As HIV seroconversions occurred after discontinuations of Pr EP , strategies to prevent inappropriate discontinuations are needed.