On-demand PrEP exceeds daily use among Chinese MSM


Event-based HIV prevention regimens appeared to have a better protective effect and tendency to medication adherence than daily regimens in a real setting among men who have sex with men (MSM), said a researcher.

In four cities in China, MSM who switched to event-triggered pre-exposure prophylaxis (PrEP) – that is, only taking the drug before and after sex – had less infections than users, respectively), reported Junjie Xu, PhD, of China Medical University in Shenyang.

The proportion of anal sex acts covered by PrEP at least 90% of the time increased during the 12-month follow-up period in event-motivated users (57.4% at month 1 vs. 77.8% at month 12, P= 0.022 for trend), while decreasing in daily users (75.1% at month 1 vs. 72.1% at month 12, P

Event PrEP is defined as taking two pills 2 to 24 hours before sex, one pill 24 hours after, and another 24 hours later (the 2 + 1 + 1 schedule). If intercourse takes place on several consecutive days, one pill should be taken every day for up to 48 hours after the last intercourse. While the World Health Organization (WHO) updated its HIV prevention guidelines in 2019 to include event-driven PrEP, the CDC only recommends daily use of PrEP for people at high risk.

Xu noted that China contributed the largest proportion (29%) of new HIV infections in the Asia-Pacific region in 2018, with infections among MSM rising from 14.7% in 2011 to 23.3% in 2018.

However, until the start of this study, PrEP was not approved in China for HIV prevention due to “a lack of high-quality local data to support widespread implementation,” he said. .

“As a result of the evidence from our study, an expert consensus has been issued to guide the implementation of PrEP at the end of 2020,” Xu added.

His group conducted the Real World Oral Admission PrEP in China (CROPrEP) study in four Chinese cities from December 2018 to October 2020. Tenofovir disoproxil / emtricitabine fumarate (TDF / FTC, or Truvada) has was offered to MSM, who were allowed to choose between daily or event PrEP regimens. At-risk MSM who were unwilling to initiate PrEP acted as a control group. The authors followed the participants every 3 months, up to 12 months.

Overall, 520 MSM chose a daily regimen, 503 chose an event-based regimen, and 507 refused to initiate PrEP. Those who initiate PrEP were younger than nonusers (29 versus 33, respectively) and had higher scores for risky behaviors.

During the follow-up period, all PrEP users had an 87% relative reduction in HIV infection, while adherent PrEP users had a 100% risk reduction. Xu noted that the seven seroconversions in the PrEP group were among the non-adherent users.

The incidence rate of HIV infection was lowest among event-triggered PrEP users (0.37 per 100 person-years), followed by daily PrEP users (0.90 per 100 person-years). -years), and was unsurprisingly higher among non-PrEP users (5.10 per 100 people). -years).

Xu concluded that the study showed that PrEP can reduce the risk of HIV among MSM in a real-world setting, with PrEP triggered by events offering “a better protective effect of HIV”.

  • Molly Walker is associate editor and covers infectious diseases for MedPage Today. She is the recipient of the J2 Achievement Award 2020 for her COVID-19 coverage. To pursue


Xu did not disclose any conflict of interest.


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