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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
HIV pre-exposure prophylaxis in transgender women: A subgroup analysis of the iPrEx trial
The Lancet HIV, Volume 2, No. 12, Year 2015
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Description
Background: Pre-exposure prophylaxis (PrEP) with oral emtricitabine and tenofovir disoproxil fumarate is used to prevent the sexual acquisition of HIV in groups at high risk such as transgender women. We used data from the iPrEx study to assess PrEP efficacy, effectiveness, and adherence in transgender women. Methods: The iPrEx trial was a randomised controlled trial of PrEP with oral emtricitabine plus tenofovir disoproxil fumarate compared with placebo in men who have sex with men (MSM) and transgender women, followed by an open-label extension. Drug concentrations were measured in blood by liquid chromatography and tandem mass spectroscopy. We did unplanned exploratory analyses to investigate differences in PrEP outcomes among transgender women and between transgender women and MSM. Findings: Of the 2499 participants enrolled in the randomised controlled trial, 29 (1%) identified as women, 296 (12%) identified as trans, 14 (1%) identified as men but reported use of feminising hormones, such that 339 (14%) reported one or more characteristics and are classified as transgender women for the purpose of this study. Compared with MSM, transgender women more frequently reported transactional sex, receptive anal intercourse without a condom, or more than five partners in the past 3 months. Among transgender women, there were 11 HIV infections in the PrEP group and ten in the placebo group (hazard ratio 1·1, 95% CI 0·5-2·7). In the PrEP group, drug was detected in none of the transgender women at the seroconversion visit, six (18%) of 33 seronegative transgender women (p<0·31), and 58 (52%) of 111 seronegative MSM (p<0·0001). PrEP use was not linked to behavioural indicators of HIV risk among transgender women, whereas MSM at highest risk were more adherent. Interpretation: PrEP seems to be effective in preventing HIV acquisition in transgender women when taken, but there seem to be barriers to adherence, particularly among those at the most risk. Studies of PrEP use in transgender women populations should be designed and tailored specifically for this population, rather than adapted from or subsumed into studies of MSM. Funding: US National Institutes of Health and the Bill & Melinda Gates Foundation. © 2015 Elsevier Ltd.
Authors & Co-Authors
Deutsch, Madeline B.
United States, San Francisco
University of California, San Francisco
Glidden, David V.
United States, San Francisco
University of California, San Francisco
McMahan, Vanessa M.
United States, San Francisco
Gladstone Institutes
Guanira, Juan Vicente
Peru, Lima
Inmensa
Kállas, Èsper Georges
Brazil, Sao Paulo
Universidade de São Paulo
Chariyalertsak, Suwat
Thailand, Chaing Mai
Chiang Mai University
Grant, Robert M.
United States, San Francisco
University of California, San Francisco
United States, San Francisco
Gladstone Institutes
United States, San Francisco
San Francisco Aids Foundation
Lama, Javier R.
United States, San Francisco
San Francisco Aids Foundation
Schechter, Mauro T.
United States, San Francisco
San Francisco Aids Foundation
Veloso, V. G.
United States, San Francisco
San Francisco Aids Foundation
Bekker, Linda-Gail Gail
United States, San Francisco
San Francisco Aids Foundation
Mayer, Kenneth H.
United States, San Francisco
San Francisco Aids Foundation
Buchbinder, Susan P.
United States, San Francisco
San Francisco Aids Foundation
Montoya, Orlando
United States, San Francisco
San Francisco Aids Foundation
Casapia, Martin
United States, San Francisco
San Francisco Aids Foundation
Hosek, Sybil G.
United States, San Francisco
San Francisco Aids Foundation
Liu, Albert Y.
United States, San Francisco
San Francisco Aids Foundation
Rivet Amico, K. Rivet
United States, San Francisco
San Francisco Aids Foundation
Mulligan, Kathleen
United States, San Francisco
San Francisco Aids Foundation
Statistics
Citations: 197
Authors: 19
Affiliations: 6
Identifiers
Doi:
10.1016/S2352-3018(15)00206-4
ISSN:
23523018
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Exploratory Study
Participants Gender
Male
Female