Human immunodeficiency virus pre-exposure prophylaxis: analysis, follow-up and pandemic effect

ABSTRACT

Background and importanceIn 2019, the National Health System (NHS) approved funding for the indication of pre-exposure prophylaxis (PreP) as an strategy to prevent human immunodeficiency virus (HIV) infection in high-risk populations. The hospital pharmacy (HP), together with the Sexually Transmitted Infection (STI) centre, has created an interdisciplinary circuit where these individuals are closely monitored.Aim and objectivesTo characterise the user population of the HIV PrEP programme and assess the adequacy of the circuit, as well as the impact of the SARS-CoV-2 pandemic.Material and methodsRetrospective observational study of the PrEP programme from November 2019 to April 2021 carried out in the provincial STI treatment centre and the HP.The following were assessed compliance with inclusion criteria, adherence to treatment and causes of discontinuation, toxicity, acquisition of STIs and interactions. Also variations during confinement and degree of involvement by COVID.Results169 males, aged 39.6±10.0 (range 19–64) years, all met at least one inclusion criterion in the last year 75.7% (n=128) men who have sex with men (MSM) with more than 10 different sexual partners, 71.6% (n=121) MSM anal sex without condoms, 17.1% (n=29) MSM drug use, 10.7% (n=18) MSM with multiple PreP, 74.0% (n=125) MSM with at least one STI and one engaged in prostitution.30 clients discontinued medication 33.3% (n=10) stopped risky practices, 20.0% (n=6) digestive toxicity (main adverse effect), 3.3% (n=1) poor adherence, 16.7% (n=5) client choice and 26.7% (n=8) drop out of follow-up. Mean adherence was 94.5±11.4.No patients acquired HIV during treatment, but other STIs were found (several users reported reduced of condom use) 36.7% (n=11) Treponema pallidum, 56.7% (n=17) Chlamydia trachomatis, 63.3% (n=19) Neisseria gonorrhoeae and 36.7% (n=11) Mycoplasma genitalum.This was a young population that does a lot of physical exercise and after the clinical interview it was discovered they were abusing protein shakes and anabolic steroids, therefore they were warned about it.During the confinement, 41 users were in treatment. Of the 37 who continued, 4 suffered from COVID.Conclusion and relevanceThe programme meets the requirements of the NHS, with high adherence to treatment and a good safety profile.Patients continued with PreP during confinement and there was a significant number affected by COVID.Clinical pharmaceutical follow-up has allowed preventive and corrective interventions, but more emphasis should be placed on the use of condoms and avoiding anabolic steroids given the possible renal repercussions.References and/or acknowledgementsConflict of interestNo conflict of interest