TY - JOUR
T1 - The impact of adherence to preexposure prophylaxis on the risk of HIV infection among people who inject drugs
AU - Martin, Michael
AU - Vanichseni, Suphak
AU - Suntharasamai, Pravan
AU - Sangkum, Udomsak
AU - Mock, Philip A.
AU - Leethochawalit, Manoj
AU - Chiamwongpaet, Sithisat
AU - Curlin, Marcel E.
AU - Na-Pompet, Supawadee
AU - Warapronmongkholkul, Anchalee
AU - Kittimunkong, Somyot
AU - Gvetadze, Roman J.
AU - McNicholl, Janet M.
AU - Paxton, Lynn A.
AU - Choopanya, Kachit
AU - Na Ayudhya, Sompob Snidvongs
AU - Kaewnil, Kraichack
AU - Kitisin, Praphan
AU - Kukavejworakit, Malinee
AU - Natrujirote, Pitinan
AU - Simakajorn, Saengchai
AU - Subhachaturas, Wonchat
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/4/24
Y1 - 2015/4/24
N2 - Objective: To describe participant adherence to daily oral tenofovir in an HIV preexposure prophylaxis (PrEP) trial, examine factors associated with adherence, and assess the impact of adherence on the risk of HIV infection. Design: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted among people who inject drugs, 2005-2012. Methods: Participants chose daily visits or monthly visits. Study nurses observed participants swallow study drug and both initialed a diary. We assessed adherence using the diary. We examined adherence by age group and sex and used logistic regression to evaluate demographics and risk behaviors as predictors of adherence and Cox regression to assess the impact of adherence on the risk of HIV infection. Results: A total of 2413 people enrolled and contributed 9665 person-years of follow-up (mean 4.0 years, maximum 6.9 years). The risk of HIV infection decreased as adherence improved, from 48.9% overall to 83.5% for those with at least 97.5% adherence. In multivariable analysis, men were less adherent than women (P = 0.006) and participants 20-29 years old (P < 0.001) and 30-39 years old (P = 0.01) were less adherent than older participants. Other factors associated with poor adherence included incarceration (P = 0.02) and injecting methamphetamine (P = 0.04). Conclusion: In this HIV PrEP trial among people who inject drugs, improved adherence to daily tenofovir was associated with a lower risk of HIV infection. This is consistent with trials among MSM and HIV-discordant heterosexual couples and suggests that HIV PrEP can provide a high level of protection from HIV infection.
AB - Objective: To describe participant adherence to daily oral tenofovir in an HIV preexposure prophylaxis (PrEP) trial, examine factors associated with adherence, and assess the impact of adherence on the risk of HIV infection. Design: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted among people who inject drugs, 2005-2012. Methods: Participants chose daily visits or monthly visits. Study nurses observed participants swallow study drug and both initialed a diary. We assessed adherence using the diary. We examined adherence by age group and sex and used logistic regression to evaluate demographics and risk behaviors as predictors of adherence and Cox regression to assess the impact of adherence on the risk of HIV infection. Results: A total of 2413 people enrolled and contributed 9665 person-years of follow-up (mean 4.0 years, maximum 6.9 years). The risk of HIV infection decreased as adherence improved, from 48.9% overall to 83.5% for those with at least 97.5% adherence. In multivariable analysis, men were less adherent than women (P = 0.006) and participants 20-29 years old (P < 0.001) and 30-39 years old (P = 0.01) were less adherent than older participants. Other factors associated with poor adherence included incarceration (P = 0.02) and injecting methamphetamine (P = 0.04). Conclusion: In this HIV PrEP trial among people who inject drugs, improved adherence to daily tenofovir was associated with a lower risk of HIV infection. This is consistent with trials among MSM and HIV-discordant heterosexual couples and suggests that HIV PrEP can provide a high level of protection from HIV infection.
KW - HIV
KW - adherence
KW - people who inject drugs
KW - preexposure prophylaxis
KW - tenofovir
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U2 - 10.1097/QAD.0000000000000613
DO - 10.1097/QAD.0000000000000613
M3 - Article
C2 - 25985403
AN - SCOPUS:84928560058
SN - 0269-9370
VL - 29
SP - 819
EP - 824
JO - AIDS
JF - AIDS
IS - 7
ER -