Prevention of sexually acquired HIV infection now includes
both consistent condom use and daily use of oral antiretroviral preexposure
prophylaxis (PrEP). Persons at substantial HIV risk can now use one or both
prevention methods, but a combined HIV protective effect has not been assessed.
We use deterministic models to examine the impact of method
adherence and rates of PrEP and male condom use on number of anticipated HIV
infections. Analyses were based on hypothetical cohorts of 10,000 African
American men who have sex with men (AAMSM), a population with the highest HIV
incidence in the United States. Parameters used in the model (condom
effectiveness, PrEP effectiveness, HIV incidence) were based on published
findings.
Among AAMSM who never use PrEP, an estimated 323 annual HIV
infections would occur among those who always use condoms, 1007 among sometimes
condom users, and 1094 among never condoms users. Among AAMSM who never (or
inconsistently) use condoms, 295 (272) infections would occur among those who
report at least 90% PrEP adherence and 744 (684) infection occur with less than
50% adherence. Among AAMSM who are consistently (or sometimes) taking PrEP, the
highest protection is seen with consistent condom use, 87 (220) HIV infections
and 92.0% (79.9%) prevention effectiveness.
Among AAMSM with inconsistent or never condom use, the
addition of PrEP at either modest or high adherence can increase HIV
protection. For consistent condom users, any PrEP use can increase HIV
protection. These analyses provide an approach for rethinking HIV risk
management by calculating combined HIV protective effects of using one or more
effective prevention methods.
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- 1From the Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA.
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