Laboratory monitoring does not meet guideline standards in up to a third of people prescribed pre-exposure prophylaxis (PrEP), investigators report in Open Forum Infectious Diseases. Almost a quarter of people were not tested for HIV before starting PrEP and follow-up tests were not ordered for a third of testing intervals.
The study population consisted of a diverse group of people prescribed PrEP in primary care settings in San Francisco.
“We observed suboptimal lab monitoring and STI [sexually transmitted infection] testing by providers,” comment the authors. “Providers did not order HIV testing before almost one-fourth of PrEP initiators and one-third of follow-up intervals, which could increase risk of HIV drug resistance and forward HIV transmission after unrecognized HIV infection.”
The investigators were also concerned about disparities in testing, with older and African-American patients less likely to receive recommended screening tests compared to other groups.
Clinical studies and real-world experience have shown that PrEP is a highly effective method of HIV prevention. Laboratory monitoring is needed to maximise the safety and effectiveness of the treatment. Guidelines recommend that individuals should be screened for HIV before starting PrEP and then every three to four months when taking the drugs. Although the two-drug combination used in PrEP is effective at preventing infection with HIV, it is not potent enough to suppress ongoing HIV replication and drug-resistant virus might emerge if an individual is taking the PrEP regimen when infected with HIV. It is also recommended that individuals receiving PrEP should have regular sexual health screens.
Little is known about the laboratory monitoring of people prescribed PrEP in primary care settings.
Investigators from San Francisco designed a study to determine if individuals were being screened for HIV before starting PrEP and also if they had regular follow-up tests. The researchers also checked whether people were having laboratory tests every six months to screen for bacterial STIs. Further analysis was undertaken to determine if any demographic factors were associated with the frequency of laboratory monitoring. Read more via AIDSmap