Low incidence of HIV infection and decreasing incidence of sexually transmitted infections among PrEP users in 2020 in Germany
Daniel Schmidt, Christian Kollan, Barbara Bartmeyer, Viviane Bremer, Tim Schikowski, Martin Friebe, Sven Schellberg, Stefan Scholten, Markus Bickel, Nikola Hanhoff, Robin Rüsenberg, Knud Schewe, The NEPOS study group, Heribert Knechten, Petra Panstruga, Axel Baumgarten, Bianca Reisenweber, Heribert Hillenbrand, Kai Zucker, Siegfried Köppe, Marc Da Silva Ribeiro, Ivanka Krznaric, Denis Pitan, Christian Lieb, Hussen Yasin, Ingo Ochlast, Irina Shnurenko, Michael Rausch, Svetlana Krasov, Sven Schellberg, Peter Stueber, Dietmar Schranz, Michael Rittweger, Hubert Schulbin, Adam Smiley, Kevin Ummard-Berger, Andreas Berger, J Lenz, Chistoph Boesecke, Martha Oberschlep, Susann Koch, Mareen Monsees, Thomas Heuchel, Manuela Richter, Andreas Bellmunt-Zschäpe, Jutta Hahn, Andreas Jenke, Stefan Pursche, Stefan Mauss, F. Berger, M. Bickel, Monja Rößler, Anette Haberl, Peter K. Schott, Pavel Khaykin, Michaela Bracone, Susanne Usadel, Tina Mattmüller, Georg Friese, Ulrike Kratz, Sandra Hertling, Dirk Berzow, Knud Schewe, Constantin Rickassel, Hans Heiken, Ansgar Rieke, Petra Becker, Katja Römer, Stefan Scholten, Andreas Roder, Christoph Wyen, Kerstin Lammersmann, Ines Ruck, Burkhard Schappert, Ulrich Kastenbauer, Ramona Pauli, Oskar Mikazans, Farhad Schabaz, Christoph D. Spinner, Stefanie Gladis, Stefan Christensen, Sabine Offermann, R. Baumann, Niels Schübel, Anja Lüssenheide, Franz Audebert, Elisabeta Sepsy, Beatrice Gospodinov, Aynur Bulut, P. Beck, Jennifer Weida, Georg Härter, Petra Schütz, Thomas E. Seidel, Sabine Mauruschat, Steve Rößler
Abstract
INTRODUCTION: Objectives of this study, as part of a nation-wide HIV pre-exposure prophylaxis (PrEP) evaluation project, were to determine the incidence of infections with HIV, chlamydia, gonorrhea, syphilis, hepatitis A/B/C in persons using PrEP, and to describe the health care funded PrEP use in Germany. Additionally, factors associated with chlamydia/gonorrhea and syphilis infections were assessed. METHODS: Anonymous data of PrEP users were collected at 47 HIV-specialty centers from 09/2019-12/2020. Incidence rates were calculated per 100 person years (py). Using longitudinal mixed models, we analyzed risk factors associated with sexually transmitted infections (STIs). RESULTS: 4620 PrEP users were included: 99.2% male, median age 38 years (IQR 32-45), 98.6% men who have sex with men (MSM). The median duration of PrEP exposure was 451 days (IQR 357-488), totaling 5132 py. Four HIV infections were diagnosed, incidence rate 0,078/100py (95% CI 0.029-0.208). For two, suboptimal adherence was reported and in the third case, suboptimal adherence and resistance to emtricitabine were observed. One infection was likely acquired before PrEP start. Incidence rates were 21.6/100py for chlamydia, 23.7/100py for gonorrhea, 10.1/100py for syphilis and 55.4/100py for any STI and decreased significantly during the observation period. 65.5% of syphilis, 55.6% of chlamydia and 50.1% of gonorrhea cases were detected by screening of asymptomatic individuals. In a multivariable analysis among MSM younger age, PrEP start before health insurance coverage and daily PrEP were associated with greater risk for chlamydia/gonorrhea. Symptom triggered testing and a history of STI were associated with a higher risk for chlamydia/gonorrhea and syphilis. A significantly lower risk for chlamydia/gonorrhea and syphilis was found for observations during the COVID-19 pandemic period. CONCLUSIONS: We found that HIV-PrEP is almost exclusively used by MSM in Germany. A very low incidence of HIV infection and decreasing incidence rates of STIs were found in this cohort of PrEP users. The results were influenced by the SARS-CoV-2 pandemic. Rollout of PrEP covered by health insurance should be continued to prevent HIV infections. Increased PrEP availability to people at risk of HIV infection through the elimination of barriers requires further attention. Investigation and monitoring with a longer follow-up would be of value.