Behavioral Impact, Acceptability, and HIV Incidence among Homosexual Men with Access to Postexposure Chemoprophylaxis for HIV

Background: Little is known about the behavioral impact, acceptability, and incidence of HIV infection in persons with easy access to post-sexual exposure prophylaxis (PEP) to prevent HIV. Methods: Participants were recruited from a well-characterized, high-risk HIV seronegative homosexual male cohort in Rio de Janeiro, Brazil, given a 4-day supply of zidovudine and lamivudine, and instructed to begin PEP immediately after an eligible exposure. For eligible exposures, an additional 24-day supply was provided. Reported behavior, PEP utilization, adverse events, and incident HIV infection were the main study outcomes. The observed and expected incidences of HIV infection were compared. Results: Two hundred subjects were enrolled and followed for a median of 24.2 months. The median age was 28 years. PEP was initiated 109 times by 68 participants (34.0%). In comparison to reported behavior at baseline, reported high-risk sexual activities on average declined over time for both PEP and non-PEP users. There were no serious drug-related adverse events. There were 11 HIV seroconversions, 10 among non-PEP users and 1 that was a PEP failure. The overall seroincidence was 2.9 per 100 person-years (95% CI = 1.4, 5.1). The expected number of new HIV infections and corresponding expected seroincidence based on the risk profile were 11.8 and 3.1, respectively (P > 0.97). The most commonly reported reasons for not initiating PEP among seroconverters were sex with a steady partner and not considering the exposure to be of sufficiently high risk to warrant PEP. Conclusion: PEP was safe and did not appear to be associated with increases in reported high-risk behavior in our cohort. Ready access to PEP did not appear to substantially affect HIV transmission, suggesting a limited public health impact of this intervention.