Study: CDC Guidelines Insufficient for Determining PrEP Candidates

A new study found that the CDC guidelines for determining if men who have sex with men should undergo pre-exposure prophylaxis (PrEP) treatment are insufficient at identifying high risk individuals, and should be expanded to include substance use, partner-level, and other syndemic variables that contribute to HIV acquisition.  

The researchers created an HIV risk score for HIV-negative men who have sex with men based on Syndemics Theory in order to develop a “more targeted criterion for assessing PrEP candidacy.”

Their study included 9481 HIV negative men who have sex with men attending the Los Angeles LGBT center between January 2009 and June 2014. Researchers used behavioral risk assessment and HIV testing data to determine the efficacy of their HIV risk score. Syndemics Theory was used to select variables for multivariable Cox proportional hazards models. The Akaike Information Criterion and Bayesian Information Criterion were used to compare the researchers’ HIV risk model with the CDC guidelines.

“Approximately 51% of MSM were above a cutpoint that we chose as an illustrative risk score to qualify for PrEP, identifying 75% of all seroconverting MSM,” the researchers wrote.

Overall, their study showed that their model was a better fit for identifying individuals with an increased risk for contracting HIV than the CDC guidelines, and was able to identify a larger portion of potential HIV infections.

“Current CDC PrEP guidelines should be expanded to incorporate substance use, partner-level, and other Syndemic variables that have been shown to contribute to HIV acquisition. Deployment of such personalized algorithms may better hone PrEP criteria and allow providers and their patients to make a more informed decision prior to PrEP use,” the researchers concluded.

—Melissa Weiss

Reference:

Beymer MR, Weiss RE, Sugar CA, et al. Are Centers for Disease Control and Prevention Guidelines for preexposure prophylaxis specific enough? Formualation of a personalized HIV risk score for pre-exposure prophylaxis initiation. Sexually Transmitted Diseases 44(1): 48-56.