AIDS (London, England) 2018 03 20() doi 10.1097/QAD.0000000000001806
Current harm reduction strategies will probably remain insufficient to eliminate HIV transmission among drug users. We aimed to estimate the HIV seroconversion rate among drug users followed at a Harm Reduction Unit (HRU) to evaluate the potential use of PrEP as a prevention tool.
DESIGN AND METHODS
A cohort of drug users have been followed at a HRU in Madrid between 2013 and 2016. Individuals who were HIV-negative at baseline and who had at least one re-test for HIV infection were eligible. Kaplan- Meier methods were employed to estimate the incidence density.
954 drug users had at least an HIV test. At baseline, 260 were HIV negative and had at least one follow-up HIV test. After 330.89 person-years (PY) of risk for HIV infection, 10 (3.8%) seroconverted. Overall incidence density of HIV seroconversion was 3.02 (95%CI; 1.4-5.5) per 100 PY, with differences according to HCV serostatus: 1.17 (95%CI; 0.1 – 4.2) per 100 PY in negative HCV subjects and 4.98 (95%CI; 2.1- 9.8) per 100 PY in positive HCV subjects. In the multivariable analysis, infection with HCV remained independently associated with time to HIV seroconversion (adjusted hazard ratio= 6.43; 95% CI: 1.1 – 36.5, p = 0.035).
Despite efforts in HIV prevention in a harm reduction unit, a high incidence of HIV was found among active drug users. Positive HCV status is a strong predictor of HIV seroconversion. In this context, PrEP implementation should be considered as an additional tool for HIV prevention in this population.