Pre-HIV-Diagnosis PrEP Use Linked to Higher Rate of Resistance to Truvada

[Jim Allen]

This is reported based on analyzed data from 3,685 individuals based in NY.

Now if you ask me, even with 100% testing before starting PrEP, due to response bias (*) and people incorrectly dismissing risks they recently have had, you are always going to have a few errors and people starting PrEP when they should wait & retest first. Although reducing those starting PrEP without testing, is an obvious call out.

P.S
Again a bit of a misleading headline, it should read something like: "Pre-PrEP HIV exposure & lack of testing linked to Higher Rate of Resistance to Truvada"

In full: https://www.poz.com/article/prehivdiagnosis-prep-use-linked-higher-rate-resistance-truvada

In short:

If someone starting PrEP was not tested for HIV prior to receiving a prescription for Truvada or if he or she is so recently infected that an HIV test yields a false negative result, the individual may wind up taking Truvada in the face of a chronic infection with the virus.

There were data on the genotypes of HIV for 75 percent of the PrEP users and 63 percent of those who had never used PrEP. Twenty-nine percent of the PrEP users had any of four mutations that confer resistance to emtricitabine, compared with 2 percent of those who had not used Truvada for prevention. Four people, none of whom had used PrEP, had K65R mutations conferring resistance to tenofovir disoproxil fumarate.

The overall findings underline the importance of conducting proper screening among those seeking PrEP to reduce the chances that people will start Truvada when they have undiagnosed HIV.

(*)

2018
https://doi.org/10.1016/j.eclinm.2018.08.001

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

We have identified falsely optimistic views of personal STI risk among a substantial proportion of those at risk of STIs in the British population, which could have a negative impact on efforts to promote safe sex and STI testing, and the control of STIs.

Among those classed as having ‘unsafe sex’ in the past year (comprising approximately 1 in 5 sexually-active 16–44-year-olds), 39.2% of men and 51.0% of women rated themselves as not at all at risk of STIs

2018
http://journals.sagepub.com/doi/abs/10.1177/0032885517753163

Underreporting in HIV-Related High-Risk Behaviors: Comparing the Results of Multiple Data Collection Methods in a Behavioral Survey of Prisoners in Iran

Participants reported more sexual contact in prison for their friends than they did for themselves. In men, NSU provided lower estimates than direct questioning, whereas in women NSU estimates were higher. Different data collection methods provide different estimates and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.

2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268760/

Socially desirability response bias and other factors that may influence self-reports of substance use and HIV risk behaviors: A qualitative study of drug users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias

2018
http://emj.bmj.com/content/35/1/46
Self-perceived risk of STIs in a population-based study of Scandinavian women

Subjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

2018
https://www.tandfonline.com/doi/abs/10.1080/09540121.2017.1384787

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa

2018
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30062-6/fulltext

Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Jim: In short they analysed the genetic code of the virus from HIV-positive people and came to the conclusion that some of the self-reported heterosexual mens HIV was more than likely actually non-disclosed MSM.

2017
https://www.ncbi.nlm.nih.gov/pubmed/28509997

Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors.

2017 --In regards to STI's
https://journals.lww.com/stdjournal/toc/2017/07000
Sexually Transmitted Diseases: July 2017 - Volume 44 - Issue 7 - p 390–392

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.

2016
https://www.sciencedirect.com/science/article/pii/S0010782416305418
Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

Jim - Not a conclusive or in depth study but under the study participants it did find: 9 out of every 20 sex acts reported with condoms are actually unprotected

2009
The Validity of Teens’ and Young Adults’ Self-reported Condom Use
https://jamanetwork.com/journals/jamapediatrics/articlepdf/380711/poa80067_61_64.pdf

A significant degree of discordance between self-reports of consistent condom use and YcPCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but
used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers

BMC Public Health 2007
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-60

Analyses of data from the Demographic and Health Surveys, Sexual Behaviour Surveys and from other countries show a similar pattern indicating under-reporting
It is probable that as HIV campaigns encouraging delayed sexual debut and abstinence before marriage reach the population, people will report behaviour
assumed to be more socially desirable.

there are some signs of differential reporting bias in our study. We found that controlling for less risky sexual behaviour substantially reduced the association between HIV and survey time among urban men, but less so among women; this may suggest that self-reports from men about sexual behaviour are more reliable. Studies suggest that respondents, especially women, tend to under-report the number of lifetime sexual partners . Therefore, analyses of associations with, and changes in, self-reported sexual behaviour should be interpreted with caution.

2010
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957626/

Self-presentation bias (wishing to be viewed in a positive light) may result in patients underreporting behaviors they perceive to be stigmatizing

Approximately a third of the men in the sample reported that they did not disclose all of their risk behaviors to the HIV counselor during the face-to-face risk assessment. These results echo similar studies of risk disclosure to medical providers