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High HIV seroconversion rate in HCV-infected drug users followed in a Harm Reduction Unit: A lost opportunity for Pre- exposure Prophylaxis.

High HIV seroconversion rate in HCV-infected drug users followed in a Harm Reduction Unit: A lost opportunity for Pre- exposure Prophylaxis.
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Valencia J, Ryan P, Alvaro-Meca A, Troya J, Gutierrez J, Cuevas G, Moreno S,


Valencia J, Ryan P, Alvaro-Meca A, Troya J, Gutierrez J, Cuevas G, Moreno S, (click to view)

Valencia J, Ryan P, Alvaro-Meca A, Troya J, Gutierrez J, Cuevas G, Moreno S,

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AIDS (London, England) 2018 03 20() doi 10.1097/QAD.0000000000001806

Abstract
OBJECTIVES
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.

RESULTS
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).

CONCLUSIONS
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.

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