{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:14:35Z","timestamp":1787066075389,"version":"build-2736575974"},"reference-count":27,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,2,19]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The efficacy of pre-exposure prophylaxis (PrEP) relies on adherence to effective regimens. As data on real-life PrEP roll-out and efficacy from Central and Eastern Europe are scarce, we explored the HIV incident infections among PrEP users in an observational cohort in Poland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cohort of 887 men having sex with men (MSM) on generic emtricitabine\/tenofovir disoproxil (FTC\/TDF) were followed for a cumulative 2587 person years (PY). HIV infection was confirmed using molecular and immunoassays, with subtype and genotyping performed at diagnosis. For phylogenetic analysis, we used 2087 HIV-1 A6 partial\n                      <jats:italic>pol<\/jats:italic>\n                      sequences from Poland as background.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine (1%) PrEP users acquired HIV during the follow-up period. The estimated HIV incidence was 0.347 per 100 PY, with a relative risk reduction of 90.9%. All users who acquired HIV were cisgender white MSM of European origin (median age: 35.5 years). The majority (eight out of nine) used PrEP on demand (ie, 2-1-1 schedule), with one using PrEP only before receptive and not insertive sexual contacts and seven skipping the double dose. Infections occurred due to inadequate PrEP dosing. In five (55.6%) and four (44.4%) users, subtypes B and A6 were acquired, respectively, with no drug resistance. Each of the four A6 sub-subtypes belonged to distinct clusters. Three of them had distinct regional origins within Poland and one in Ukraine. Users were started on tenofovir alafenamide\/emtricitabine\/bictegravir at a median of 10.5\u2009days from diagnosis and reached undetectable viral load (&lt;50 copies\/mL) at a median of 63 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, FTC\/TDF PrEP was very effective, with failures occurring due to suboptimal adherence to on-demand dosing. Effective communication of HIV-related risks and clear instructions on how to use on-demand PrEP without missing doses should be provided to PrEP users. Despite the lack of transmitted drug resistance, we noted a higher number of infections with the A6 subtype and independent lineage introductions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2024-056329","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T13:20:42Z","timestamp":1740662442000},"page":"450-455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["HIV incident infections during pre-exposure prophylaxis (PrEP) use in Wroclaw, Poland, 2017\u20132023: a real-life experience"],"prefix":"10.1136","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7178-9801","authenticated-orcid":false,"given":"Bartosz","family":"Szetela","sequence":"first","affiliation":[{"name":"Infectious Diseases, Liver Disease and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland"},{"name":"All Saints Clinic, Wroclawskie Centrum Zdrowia SP ZOZ, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol","family":"Serwin","sequence":"additional","affiliation":[{"name":"Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Bozejko","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Liver Disease and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Zinczuk","sequence":"additional","affiliation":[{"name":"All Saints Clinic, Wroclawskie Centrum Zdrowia SP ZOZ, Wroclaw, Poland"},{"name":"1st Department of Infectious Diseases, Gromkowski Specialist Regional Hospital, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamila","family":"Zielinska","sequence":"additional","affiliation":[{"name":"All Saints Clinic, Wroclawskie Centrum Zdrowia SP ZOZ, Wroclaw, Poland"},{"name":"1st Department of Infectious Diseases, Gromkowski Specialist Regional Hospital, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukasz","family":"Lapinski","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary Medicine, Wroc\u0142aw University of Environmental and Life Sciences, Wroclaw, Poland"},{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Szymczak","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Liver Disease and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland"},{"name":"All Saints Clinic, Wroclawskie Centrum Zdrowia SP ZOZ, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Urbanska","sequence":"additional","affiliation":[{"name":"Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"G\u0105siorowski","sequence":"additional","affiliation":[{"name":"All Saints Clinic, Wroclawskie Centrum Zdrowia SP ZOZ, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1869-1084","authenticated-orcid":false,"given":"Mi\u0142osz","family":"Parczewski","sequence":"additional","affiliation":[{"name":"Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"2025101602151352000_101.7.450.1","unstructured":"EACS guidelines 2023, Available: https:\/\/www.eacsociety.org\/guidelines\/eacs-guidelines\/eacs-guidelines.html [Accessed 7 May 2024]."},{"key":"2025101602151352000_101.7.450.2","unstructured":"Parczewski M , Witak-J\u0119dra M , Aksak-W\u0105s B . Zasady opieki nad osobami zaka\u017conymi hiv. In: Zalecenia PTN AIDS 2023. Warszawa\u2013Szczecin: Polskie Towarzystwo Naukowe AIDS 2023. 2023."},{"key":"2025101602151352000_101.7.450.3","unstructured":"Centers for Disease Control and Prevention . Preexposure Prophylaxis for the Prevention of HIV Infection in the United States \u2013 2021 Update Clinical Practice Guideline, 2021. Available: https:\/\/www.cdc.gov\/hiv\/pdf\/risk\/prep\/cdc-hiv-prep-guidelines-2021.pdf [Accessed 7 May 2024]."},{"key":"2025101602151352000_101.7.450.4","doi-asserted-by":"crossref","first-page":"e554","DOI":"10.1016\/S2352-3018(22)00133-3","article-title":"Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study","volume":"9","author":"Molina","year":"2022","journal-title":"Lancet HIV"},{"key":"2025101602151352000_101.7.450.5","first-page":"609","article-title":"Drug Resistance During HIV Pre-Exposure Prophylaxis","volume":"79","author":"Gibas","year":"2019","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025101602151352000_101.7.450.6","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001960"},{"key":"2025101602151352000_101.7.450.7","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12989"},{"key":"2025101602151352000_101.7.450.8","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000003143"},{"key":"2025101602151352000_101.7.450.9","doi-asserted-by":"crossref","unstructured":"Szetela B , Cielniak I , Kubicka J , et al . Pre-exposure prophylaxis (PrEP) in Poland 2017 to 2021: lessons from a country with no national PrEP programme. JIAS 2022;25. doi:10.1002\/jia2.26009","DOI":"10.1002\/jia2.26009"},{"key":"2025101602151352000_101.7.450.10","unstructured":"Los Alamos National Laboratory . HIV sequence database, 2023. Available: https:\/\/www.hiv.lanl.gov [Accessed 1 Jul 2024]."},{"key":"2025101602151352000_101.7.450.11","unstructured":"Rosinska M , Wagner N . Raport ko\u0144cowy w ramach umowy nr 6\/4\/3\/npz\/2018\/1094\/120. zadanie 2 pn. \u201eokre\u015blenie cz\u0119sto\u015bci wyst\u0119powania nowych zaka\u017ce\u0144 wirusem hiv na podstawie bada\u0144 serologicznych r\u00f3\u017cnicuj\u0105cych noworozpoznane zaka\u017cenia na wczesne i d\u0142ugotrwaj\u0105ce\u201d. narodowy instytut zdrowia publicznego - pa\u0144stwowy zak\u0142ad higieny, krajowe centrum ds. aids. 2019. Available: https:\/\/aids.gov.pl\/publikacje\/raport-pzh-hiv\/ [accessed 11 Aug 2024]"},{"key":"2025101602151352000_101.7.450.12","doi-asserted-by":"publisher","DOI":"10.1093\/molbev\/msaa015"},{"key":"2025101602151352000_101.7.450.13","doi-asserted-by":"crossref","DOI":"10.1002\/jmv.29482","article-title":"Phylodynamic evolution of HIV-1 A6 sub-subtype epidemics in Poland","volume":"96","author":"Serwin","year":"2024","journal-title":"J Med Virol"},{"key":"2025101602151352000_101.7.450.14","doi-asserted-by":"publisher","DOI":"10.1093\/molbev\/msaa284"},{"key":"2025101602151352000_101.7.450.15","doi-asserted-by":"crossref","DOI":"10.1093\/ve\/vey016","article-title":"Bayesian phylogenetic and phylodynamic data integration using BEAST 1.10","volume":"4","author":"Suchard","year":"2018","journal-title":"Virus Evol"},{"key":"2025101602151352000_101.7.450.16","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200309050-00005"},{"key":"2025101602151352000_101.7.450.17","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25389","article-title":"Motives for choosing, switching and stopping daily or event-driven pre-exposure prophylaxis - a qualitative analysis","volume":"22","author":"Zimmermann","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2025101602151352000_101.7.450.18","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25733","article-title":"Imperfect adherence in real life: a prevention-effective perspective on adherence to daily and event-driven HIV pre-exposure prophylaxis among men who have sex with men - a prospective cohort study in Taiwan","volume":"24","author":"Wu","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"2025101602151352000_101.7.450.19","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2020.100650","article-title":"Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men","volume":"29\u201330","author":"Coyer","year":"2020","journal-title":"EClinicalMedicine"},{"key":"2025101602151352000_101.7.450.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-19198-y","article-title":"Dynamics of HIV PrEP use and coverage during and after COVID-19 in Germany","volume":"24","author":"Schmidt","year":"2024","journal-title":"BMC Public Health"},{"key":"2025101602151352000_101.7.450.21","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2022.100486","article-title":"Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021","volume":"22","author":"Billioti de Gage","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"2025101602151352000_101.7.450.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506273"},{"key":"2025101602151352000_101.7.450.23","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(15)00056-2","article-title":"Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"387","author":"McCormack","year":"2016","journal-title":"The Lancet"},{"key":"2025101602151352000_101.7.450.24","doi-asserted-by":"crossref","first-page":"e767","DOI":"10.1016\/S2352-3018(23)00261-8","article-title":"Efficacy and safety of long-acting cabotegravir compared with daily oral tenofovir disoproxil fumarate plus emtricitabine to prevent HIV infection in cisgender men and transgender women who have sex with men 1 year after study unblinding: a secondary analysis of the phase 2b and 3 HPTN 083 randomised controlled trial","volume":"10","author":"Landovitz","year":"2023","journal-title":"Lancet HIV"},{"key":"2025101602151352000_101.7.450.25","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy297"},{"key":"2025101602151352000_101.7.450.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2018.08.006"},{"key":"2025101602151352000_101.7.450.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0292289","article-title":"Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation development from a nationally implemented PrEP programme","volume":"18","author":"MacDonald","year":"2023","journal-title":"PLoS One"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2024-056329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T09:15:33Z","timestamp":1760606133000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2024-056329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/sextrans-2024-056329"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2024-056329","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}