Article Text
Statistics from Altmetric.com
Gender and ethnicity disparity in HIV pre-exposure prophylaxis use following routine commissioning in England
In England, HIV pre-exposure prophylaxis (PrEP) was initially available through the Impact trial (2017–2020), which primarily comprised of men who have sex with men (MSM)1. This study compared changes in PrEP access following the roll-out of commissioned, routine HIV PrEP in 2021. Overall PrEP use increased threefold, with use in heterosexual men increasing from 1% to 13%. Despite women accounting for 27% of all new HIV diagnoses, they still represent only 2% of PrEP users. The wide equity gap was especially evident among black African women who represented <1% of PrEP users both pre-commissioning and post-commissioning, while accounting for an increasing share of new HIV diagnoses (10% in 2021 vs 8% pre-commissioning). There is an urgent need to address barriers to PrEP access among underserved populations.
Coukan F, Sullivan A, Mitchell H, et al. Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: a PrEP-to-need ratio investigation. Sex Transm Infect 2024;100:166–172. Published 2024 Apr 18. doi:10.1136/sextrans-2023–0 55 989
Change in lymphogranuloma venereum epidemiology among men in France indicates need for wider testing indications
Nationwide testing in France between 2010 and 2015 showed that lymphogranuloma venereum (LGV) was more prevalent in individuals with anorectal symptoms and/or HIV-seropositivity. Consequently, since 2016, LGV screening has been restricted to these selected populations. This study investigated C. trachomatis-positive anorectal samples from 59 laboratories across France for the presence of LGV using real-time PCR. In 2020, 2021 and 2022, among 3191 samples (90% from men), LGV positivity was 13%, 15% and 13% in each year, respectively. Asymptomatic anorectal LGV increased from 36% in 2020 to 52% in 2022. Across survey years, over 50% of LGV diagnoses were in HIV-negative individuals, occurring more commonly among HIV PrEP users than non-PrEP users. This shift in LGV epidemiology shows that less selective testing should be offered.
Peuchant O, Laurier-Nadalié C, Albucher L, Balcon C, Dolzy A, Hénin N, Touati A, Bébéar C. Anachla study group. Anorectal lymphogranuloma venereum among men who have sex with men: a 3-year nationwide survey, France, 2020 to 2022. Euro Surveill. 2024;29:2300520. doi: 10.2807/1560-7917.ES.2024.29.19.2300520. PMID: 38726697; PMCID: PMC11083974.
Doxycycline post-exposure prophylaxis and meningococcal group B vaccine for preventing bacterial sexually transmitted infections
The open-label ANRS 174 DOXYVAC trial randomised 556 MSM to doxycycline postexposure prophylaxis (DoxyPEP) (200 mg within 24–72 hours after sex) or no PEP and to meningococcal group B vaccine (4CMenB) vaccine or no vaccine in a 2×2 design. DoxyPEP significantly reduced the incidence of chlamydia and syphilis (adjusted HR (aHR) 0.17; 95% CI 0.12 to 0.26) and was generally well tolerated. Its effectiveness against gonorrhoea was modest (aHR 0.67; 95% CI 0.52 to 0.87), presumably due to prevalent tetracycline-resistant strains. 4CMenB had a moderate effect on gonorrhoea incidence (aHR 0.78; 95% CI 0.60 to 1.01). Further data are needed to fully establish the benefit of 4CMenB vaccination in reducing incidence of gonorrhoea at the population level.
Jean-Michel M, Beatrice B, Lambert A, Emma R, Michele A-G, Gilles P, et al. Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2×2 factorial design. Lancet Infect Dis. 2024. Published 2024 May 23. doi: https://doi.org/10.1016/S1473-3099(24)00236-6
Safety and efficacy of bictegravir co-formulated with emtricitabine and tenofovir alafenamide in pregnant women living with HIV
This retrospective multicentre study analysed the outcomes of 147 pregnancies occurring on bictegravir co-formulated with emtricitabine and tenofovir alafenamide (B/F/TAF). Of these, 57% received B/F/TAF preconception and continued in pregnancy, 40% started B/F/TAF during pregnancy and 3% received B/F/TAF preconception and discontinued in pregnancy. Virological suppression (HIV-1 RNA <50 copies/mL) at delivery was observed in 90% overall and was highest (96%) in the preconception-continued use group and lowest (60%) in the preconception-discontinued use group. The study was underpowered to show perinatal outcomes; however, the preterm birth rate was 17.7% and the overall fetal anomaly rate was 4.1% (2.4% in the preconception group). One case of HIV transmission occurred in a patient with likely acute HIV infection during pregnancy who started B/F/TAF at 31 weeks. The study provides reassurance on the safety and efficacy of B/F/TAF in pregnancy.
Holt LM, Short WR, Momplaisir F, Hyun E, McKinney J, Lugo Morales A, Duque A, Druyan B, Ndubizu C, Duthely L, Joseph N, Sheth A, Badell ML. Bictegravir Use During Pregnancy: A Multi-Center Retrospective Analysis Evaluating HIV Viral Suppression and Perinatal Outcomes. Clin Infect Dis 2024 Apr 26:ciae218. doi: 10.1093/cid/ciae218. Epub ahead of print. PMID: 38666408.
Factors associated with human papillomavirus vaccine initiation and completion among women
Human papillomavirus (HPV) is the most common sexually transmitted infection in the world.2 This systematic review identified 63 cross-sectional studies (49 from the USA) exploring how socioeconomic and health-related characteristics relate to HPV vaccination initiation and/or completion in women. Broadly, findings indicated that measures of higher socioeconomic status (eg, health insurance, higher annual income) and a history of healthcare utilisation (eg, for a prior STI or for influenza vaccination) were associated with HPV vaccination initiation and completion. Additionally, HPV vaccination initiation was more likely among younger women and those born in the country of the study. Factors associated with vaccination completion included being white (vs black), higher education and a history of cervical cancer screening. Public health strategies are needed to improve equity of uptake and completion of HPV vaccination among women.
Okoli GN, Neilson CJ, Grossman Moon A, Kimmel Supron H, Soos AE, Grewal A, Etsell K, Alessi-Severini S, Richardson C, Harper DM. Exploration of individual socioeconomic and health-related characteristics associated with human papillomavirus vaccination initiation and vaccination series completion among adult females: a comprehensive systematic evidence review with meta-analysis. Vaccine 2024:S0264-410X(24)00601-7. doi: 10.1016/j.vaccine.2024.05.042. Epub ahead of print. PMID: 38796328.
Novel recombinant Chlamydia trachomatis vaccine shows promise in phase I trial
This phase I, double-blind, randomised, placebo-controlled trial assessed the safety (primary outcome) and immunogenicity (secondary outcome) of CTH522, a recombinant vaccine containing the major outer membrane of Chlamydia trachomatis (CT) with a liposomal adjuvant. Sixty-five healthy men and women aged 18–45 years without pre-existing CT genital infection were randomised. Six groups compared two dose concentrations (15 μg or 85 μg intramuscular vaccination), two different adjuvants (CAF01 or CAF09b) and three boosting approaches (intramuscular with adjuvant or intradermal or topical ocular (TO) without liposomal adjuvant) with a placebo arm. Only 7/65 (0.8%) participants reported grade 3 (severe) adverse events (AEs), while frequent AEs included pain at injection sites (intramuscular), ocular reactions (TO) and myalgia. Results indicated 100% anti-CTH522 IgG seroconversion in all active arms. These promising findings pave the way for further evaluation in phase II trials against ocular trachoma and urogenital chlamydia.
Pollock KM, Borges ÁH, Cheeseman HM, Rosenkrands I, Schmidt KL, Søndergaard RE, Day S, Evans A, McFarlane LR, Joypooranachandran J, Amini F. An investigation of trachoma vaccine regimens by the chlamydia vaccine CTH522 administered with cationic liposomes in healthy adults (CHLM-02): a phase 1, double-blind trial. Lancet Infect Dis. 2024 Apr 11. DOI: https://doi.org/10.1016/S1473-3099(24)00147-6
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Footnotes
Handling editor Anna Maria Geretti
X @drdaska, @raynerkjtan
Contributors All authors have contributed equally and RH will act as guarantor
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.