Modeling the Probability of HIV Infection over Time in High-Risk Seronegative Participants Receiving Placebo in Five Randomized Double-Blind Placebo-Controlled HIV Pre-Exposure Prophylaxis Trials: A Patient-Level Pooled Analysis
Maria Garcia-Cremades,
Craig W. Hendrix,
Priya Jayachandran,
Natasha Strydom,
Leah Jarlsberg,
Robert Grant,
Connie L. Celum,
Michael Martin,
Jared M. Baeten,
Jeanne Marrazzo,
Peter Anderson,
Kachit Choopanya,
Suphak Vanichseni,
David V. Glidden,
Radojka M. Savic
Affiliations
Maria Garcia-Cremades
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
Craig W. Hendrix
Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
Priya Jayachandran
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
Natasha Strydom
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
Leah Jarlsberg
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
Robert Grant
Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
Connie L. Celum
Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA 98104, USA
Michael Martin
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA
Jared M. Baeten
Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA 98104, USA
Jeanne Marrazzo
Division of Infectious Diseases, University of Alabama at Birmingham Medical Center, Birmingham, AL 35294, USA
Peter Anderson
Department of Pharmaceutical Sciences, University of Colorado, Denver, CO 80045, USA
Kachit Choopanya
Bangkok Tenofovir Study Group, Bangkok 10600, Thailand
Suphak Vanichseni
Bangkok Tenofovir Study Group, Bangkok 10600, Thailand
David V. Glidden
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
Radojka M. Savic
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
The World Health Organization recommends pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV infection. The aim of this analysis is to quantify the individual risk of HIV infection over time, using a large database of high-risk individuals (n = 5583). We used data from placebo recipients in five phase III PrEP trials: iPrEx, conducted in men who have sex with men and transgender women; VOICE, conducted in young women at high sexual risk; Partners PrEP, conducted in HIV serodiscordant heterosexual couples; TDF2, conducted in high-risk heterosexual men and women; and BTS, conducted in persons who inject drugs. The probability of HIV infection over time was estimated using NONMEM7.4. We identified predictors of HIV risk and found a substantial difference in the risk of infection among and within trial populations, with each study including a mix of low, moderate, and high-risk individuals (p < 0.05). Persons who were female at birth were at a higher risk of HIV infection than people who were male at birth. Final models were integrated in a tool that can assess person-specific risk and simulate cumulative HIV risk over time. These models can be used to optimize future PrEP clinical trials by identifying potential participants at highest risk.
