Missed opportunities of HIV pre-exposure prophylaxis in France: a retrospective analysis in the French DAT'AIDS cohort.

AIDS Serodiagnosis Adult Africa, Western Anti-HIV Agents / therapeutic use Cohort Studies Delayed Diagnosis Female France HIV Infections / prevention & control HIV-1 Homosexuality, Male Humans Male Middle Aged Pre-Exposure Prophylaxis Retrospective Studies Sexual Behavior Sexual Partners Transgender Persons Unsafe Sex
HIV HIV testing Missed opportunities PrEP Pre-exposure prophylaxis

Journal

BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551

Informations de publication

Date de publication:
25 Mar 2019
Historique:
received: 10 10 2018
accepted: 18 03 2019
entrez: 27 3 2019
pubmed: 27 3 2019
medline: 1 5 2019
Statut: epublish

Résumé

HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016. Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.

Sections du résumé

BACKGROUND BACKGROUND
HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016.
METHODS METHODS
Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area.
RESULTS RESULTS
Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%).
CONCLUSION CONCLUSIONS
With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.

Identifiants

DOI: 10.1186/s12879-019-3915-5 PMID: 30909885 PMC: PMC6434788
pubmed: 30909885
doi: 10.1186/s12879-019-3915-5
pii: 10.1186/s12879-019-3915-5
pmc: PMC6434788
doi:

Substances chimiques

Anti-HIV Agents 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

278

Investigateurs

C Drobacheff-Thiébaut (C)
A Foltzer (A)
K Bouiller (K)
L Hustache-Mathieu (L)
C Chirouze (C)
Q Lepiller (Q)
F Bozon (F)
O Babre (O)
P Muret (P)
H Laurichesse (H)
O Lesens (O)
M Vidal (M)
N Mrozek (N)
C Aumeran (C)
O Baud (O)
V Corbin (V)
P Letertre (P)
S Casanova (S)
J Prouteau (J)
C Jacomet (C)
B Hoen (B)
I Lamaury (I)
I Fabre (I)
E Curlier (E)
R Ouissa (R)
K Schepers (K)
C Herrmann-Storck (C)
N Dournon (N)
D Merrien (D)
P Perré (P)
T Guimard (T)
O Bollangier (O)
S Leautez (S)
M Morrier (M)
F Ader (F)
F Biron (F)
A Boibieux (A)
L Cotte (L)
T Ferry (T)
P Miailhes (P)
T Perpoint (T)
S Roux (S)
S Degroodt (S)
C Brochier (C)
F Valour (F)
C Chidiac (C)
C Dhiver (C)
M Saadia Mokhtari (MS)
A Ménard (A)
H Tissot Dupont (HT)
C Toméi (C)
L Meddeb (L)
A Y Belkhir (AY)
I Ravaux (I)
S Brégigeon (S)
O Zaegel-Faucher (O)
V Obry-Roguet (V)
H Laroche (H)
M Orticoni (M)
M J Soavi (MJ)
P Geneau de Lamarlière (PG)
E Ressiot (E)
M J Ducassou (MJ)
I Jaquet (I)
S Galie (S)
A Galinier (A)
P Martinet (P)
M Landon (M)
A S Ritleng (AS)
A Ivanova (A)
C Debreux (C)
C Lions (C)
I Poizot-Martin (I)
S Abel (S)
L Cuzin (L)
Nguyen S Pierre-François (NS)
J Pasquier (J)
M Pircher (M)
K Rome (K)
B Rozé (B)
A Cabié (A)
N Atoui (N)
V Le Moing (V)
A Makinson (A)
N Meftah (N)
C Merle de Boever (CM)
B Montes (B)
A Montoya Ferrer (AM)
J Reynes (J)
M André (M)
L Boyer (L)
M P Bouillon (MP)
M Delestan (M)
T May (T)
C Allavena (C)
C Bernaud (C)
E Billaud (E)
C Biron (C)
B Bonnet (B)
S Bouchez (S)
D Boutoille (D)
C Brunet-Cartier (C)
C Deschanvres (C)
N Hall (N)
T Jovelin (T)
P Morineau (P)
V Reliquet (V)
H Hue (H)
S Sécher (S)
M Cavellec (M)
A Soria (A)
V Ferré (V)
E André-Garnier (E)
A Rodallec (A)
M Lefebvre (M)
O Grossi (O)
O Aubry (O)
F Raffi (F)
P Pugliese (P)
S Breaud (S)
C Ceppi (C)
J Courjon (J)
E Cua (E)
J Cottalorda (J)
P Dellamonica (P)
E Demonchy (E)
A De Monte (A)
J Durant (J)
C Etienne (C)
S Ferrando (S)
J G Fuzibet (JG)
R Garraffo (R)
A Joulie (A)
K Risso (K)
V Mondain (V)
A Naqvi (A)
N Oran (N)
I Perbost (I)
S Pillet (S)
B Prouvost-Keller (B)
C Pradier (C)
S Wehrlen-Pugliese (S)
V Rio (V)
E Rosenthal (E)
S Sausse (S)
G Zouzou (G)
L Hocqueloux (L)
T Prazuck (T)
C Gubavu (C)
A Sève (A)
M Niang (M)
C Boulard (C)
A Cheret (A)
C Goujard (C)
Y Quertainmont (Y)
E Teicher (E)
N Lerolle (N)
D Vittecoq (D)
O Deradji (O)
F Fourreau (F)
C Pallier (C)
A Barrail-Tran (A)
R Landman (R)
V Joly (V)
C Rioux (C)
S Lariven (S)
A Gervais (A)
F X Lescure (FX)
S Matheron (S)
F Louni (F)
C Godard (C)
Z Julia (Z)
M Chansombat (M)
D Rahli (D)
C Mackoumbou-Nkouka (C)
C Charpentier (C)
D Descamps (D)
G Peytavin (G)
Y Yazdanpanah (Y)
P H Consigny (PH)
G Cessot (G)
P Bossi (P)
J Goesch (J)
J Gilquin (J)
G Benabdelmoumen (G)
F Lanternier (F)
C Charlier (C)
K Amazzough (K)
B Henry (B)
B Pilmis (B)
C Rouzaud (C)
M Morgand (M)
F Touam (F)
C Louisin (C)
C Duvivier (C)
O Lortholary (O)
R Guery (R)
F Danion (F)
J Lourenco (J)
P Parize (P)
N Etienne (N)
M Launay (M)
C Rouzioux (C)
V Avettand Fenoel (VA)
M A Valantin (MA)
F Caby (F)
R Tubiana (R)
R Agher (R)
S Seang (S)
L Schneider (L)
R PaLich (R)
C Blanc (C)
C Katlama (C)
J L Berger (JL)
Y N'Guyen (Y)
D Lambert (D)
D Lebrun (D)
I Kmiec (I)
M Hentzien (M)
V Brodard (V)
F Bani-Sadr (F)
E Botelho-Nevers (E)
A Gagneux-Brunon (A)
A Frésard (A)
F Lucht (F)
P Fischer (P)
M Partisani (M)
C Cheneau (C)
M Priester (M)
M L Batard (ML)
C Bernard-Henry (C)
E de Mautort (E)
D Rey (D)
M Alvarez (M)
N Biezunski (N)
A Debard (A)
C Delpierre (C)
P Lansalot (P)
L Lelièvre (L)
G Martin-Blondel (G)
M Piffaut (M)
L Porte (L)
K Saune (K)
P Delobel (P)
F Ajana (F)
I Alcaraz (I)
V Baclet (V)
A Boucher (A)
P Choisy (P)
T Huleux (T)
B Lafon-Desmurs (B)
H Melliez (H)
A Meybeck (A)
A Pasquet (A)
M Pradier (M)
O Robineau (O)
N Viget (N)
M Valette (M)

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Auteurs

C Lions (C)

APHM Hôpital Sainte-Marguerite, Service d'Immuno-hématologie clinique, Aix-Marseille University, Marseille, France.

O Cabras (O)

Service des maladies infectieuses et tropicales, CHU Bichat, Paris, France.

L Cotte (L)

Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France.

T Huleux (T)

Service Universitaire des maladies infectieuses et du voyageur, CH Tourcoing, Tourcoing, France.

A Gagneux-Brugnon (A)

Service d'Infectiologie, CHU Sainte-Etienne, Groupe Immunité des Muqueuses et Agents Pathogènes, Institut Presage, Université de Lyon, Lyon, France.

A Makinson (A)

Infectious and Tropical Diseases Department, University Hospital Montpellier, Montpellier, France.
UMI 233/INSERMU1175, IRD, University Montpellier, Montpellier, France.

A Cabié (A)

Service des maladies infectieuses et tropicales, CHU de Martinique, INSERM CIC 1425 and Université des Antilles EA 4537, La Martinique, France.

B Bonnet (B)

Maladies Infectieuses et tropicales, CHU HOTEL DIEU, Nantes, France.

C Duvivier (C)

APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'infectiologie Necker-Pasteur, F-75015, Paris, France.
Institut Pasteur, Centre Médical de l'Institut Pasteur, Centre d'infectiologie Necker-Pasteur, F-75015, Paris, France.
Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil EA 7327, F-75015, Paris, France.
IHU Imagine, F-75015, Paris, France.

L Hocqueloux (L)

Service des maladies infectieuses et tropicales, CHR d'Orléans -La Source, Orléans, France.

E Cua (E)

Service des maladies infectieuses et tropicales, CHU de Nice, Nice, France.

A Cheret (A)

Service de Médecine Interne, CHU Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France.

L Hustache-Mathieu (L)

Service des maladies infectieuses et tropicales, CHU Besançon, Besançon, France.

V Obry-Roguet (V)

APHM Hôpital Sainte-Marguerite, Service d'Immuno-hématologie clinique, Aix-Marseille University, Marseille, France.

C Jacomet (C)

Service des maladies infectieuses et tropicales, CHU Clermont Ferrand, Clermont Ferrand, France.

I Poizot-Martin (I)

APHM Hôpital Sainte-Marguerite, Service d'Immuno-hématologie clinique, Aix-Marseille University, Marseille, France. isabelle.poizot@ap-hm.fr.
Aix-Marseille Univ, INSERM, IRD, SESSTIM, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Aix Marseille Univ, Marseille, France. isabelle.poizot@ap-hm.fr.
Immuno hematological Unit/ service d'Immuno- hématologie Clinique, Centre d'Informations et de Soins de l'Immunodéficience Humaine et des Hépatites virales, 270 boulevard de Sainte Marguerite, 13009, Marseille, France. isabelle.poizot@ap-hm.fr.
ORCID: 0000-0002-5676-5411

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Classifications MeSH

Recherchemedicale.com › Techniques d'investigation › Techniques immunologiques › Tests immunologiques › Tests sérologiques › Sérodiagnostic du SIDA › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Personnes › Tranches d'âge › Adulte › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Ouest › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Antirétroviraux › Agents antiVIH › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Retard de diagnostic › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Régions géographiques › Europe › France › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Virus › Virus à ARN › Retroviridae › Lentivirus › Lentivirus des primates › VIH (Virus de l'Immunodéficience Humaine) › VIH-1 (Virus de l'Immunodéficience Humaine de type 1) › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Sexualité › Homosexualité › Homosexualité masculine › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Pratiques en santé publique › Prévention primaire › Prophylaxie pré-exposition › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Comportement et mécanismes comportementaux › Comportement › Comportement sexuel › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Personnes › Partenaire sexuel › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Personnes › Disparités en matière de santé, minorités et populations vulnérables › Minorités sexuelles › Personnes transgenres › Missed opportunities of HIV pre-exposure...
Recherchemedicale.com › Comportement et mécanismes comportementaux › Comportement › Comportement sexuel › Rapports sexuels non protégés › Missed opportunities of HIV pre-exposure...