Pedro Carneiro

On this session we learned about PrEP use in multiple contexts and associated issues such as chemsex, risk for HCV infection and also investigations of possible drug-drug interactions between feminizing hormones and tenofovir

Sara Paparini conducted a qualitative study of around 20 participants using the so-called “DYI” PrEP in London, UK – i.e., when individuals purchase generic PrEP online. John de Wit reported on the PrEP demonstration project in Melbourne, Australia. Mohamed Hammoud discussed an Australian study investigating PrEP being used as harm reduction among men engaging in ChemSex, specifically methamphetamine and Viagra. Elske Hoornenborg showed results from the Dutch cohort of patients taking PrEP and elevated risk for primary Hepatitis C and reinfections. Gaston Djomand, from the CDC, reported on the outcomes of PrEP funding via PEPFAR in Sub-Saharan Africa. Mackenzie Cottrell found altered TFVdp:dATP ratios in rectal tissue and serum in transgender women who received tenofovir based ARV and feminizing hormones. Akarin Hiransuthikul demonstrated lower plasma TFV exposure (13%) when daily oral feminizing hormones are used along with daily PrEP in the iFACT study.

Overall, the studies showed uptake of PrEP in diverse communities. Both the Australian and British studies found participants using PrEP in a hard reduction approach. There was a significant uptake in PrEP in sub-Saharan Africa PEPFAR funded programs. In addition to the many benefits of PrEP there needs to be monitoring for hepatitis C infection as incidence may be elevated among MSM. Although PrEP does not appear to affect estradiol levels 2 studies show pharmacodynamic interactions that may reduce tenofovir exposure. Further investigation needs to undertaken to investigate whether this is of clinical significance.