Portal de Periódicos da CAPES

Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

2019; BMJ; Volume: 9; Issue: 6 Linguagem: Inglês

10.1136/bmjopen-2018-028768

2044-6055

Zoë R. Greenwald, Mathieu Maheu‐Giroux, Jason Szabo, Judith Alexia B Robin, Michel Boissonnault, Vinh‐Kim Nguyen, Réjean Thomas,

Sex work and related issues

Purpose The l’Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l’Actuel, a large sexual health clinic located in Montreal, Canada. Participants Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. The l’Actuel PrEP Cohort contains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America. Findings to date No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start. Future plans The l’Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.