{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:36:00Z","timestamp":1762508160739,"version":"3.40.5"},"reference-count":34,"publisher":"European Centre for Disease Control and Prevention (ECDC)","issue":"28","license":[{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,16]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Guidelines for pre-exposure prophylaxis (PrEP) provide criteria to identify individuals at higher risk of HIV infection. We compared the ability to predict HIV seroconversion of four guidelines: the World Health Organization (WHO), the United States Public Health Service and Centers for Disease Control and Prevention (US CDC), the European AIDS Clinical Society (EACS) and the Portuguese National Health Service (PNHS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>We aimed to measure the association between guideline-specific eligibility and HIV seroconversion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found 28 incident cases (IR: 1.62\/100 PY; 95% confidence interval (CI) 1.12\u20132.35). Guidelines\u2019 sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46\/100 PY; IRR\u202f=\u202f4.61; 95% CI: 1.60\u201313.27) and lowest for the WHO guideline (1.89\/100 PY; IRR\u202f=\u202f1.52; 95% CI: 0.69\u20133.35).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Being identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2807\/1560-7917.es.2020.25.28.1900636","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T15:55:19Z","timestamp":1594914919000},"update-policy":"https:\/\/doi.org\/10.2807\/1560-7917.es.crp2020","source":"Crossref","is-referenced-by-count":5,"title":["Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014\u20132018"],"prefix":"10.2807","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9055-7491","authenticated-orcid":false,"given":"Paula","family":"Meireles","sequence":"first","affiliation":[{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-7483","authenticated-orcid":false,"given":"Michael","family":"Plankey","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center, Georgetown University, Washington DC, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-2419","authenticated-orcid":false,"given":"Miguel","family":"Rocha","sequence":"additional","affiliation":[{"name":"Coalition PLUS Community-Based Research Laboratory, Patin, France"},{"name":"GAT\u2013Grupo de Ativistas em Tratamentos, Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9566-8123","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Brito","sequence":"additional","affiliation":[{"name":"Coalition PLUS Community-Based Research Laboratory, Patin, France"},{"name":"GAT\u2013Grupo de Ativistas em Tratamentos, Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7595-4499","authenticated-orcid":false,"given":"Lu\u00eds","family":"Mend\u00e3o","sequence":"additional","affiliation":[{"name":"Coalition PLUS Community-Based Research Laboratory, Patin, France"},{"name":"GAT\u2013Grupo de Ativistas em Tratamentos, Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-6571","authenticated-orcid":false,"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal"},{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"}]}],"member":"7995","reference":[{"issue":"9641","key":"r1","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0140-6736(08)60888-0","article-title":"Coming to terms with complexity: a call to action for HIV 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States.","volume":"60","author":"Smith","year":"2012","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"3","key":"r8","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1093\/cid\/civ335","article-title":"Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men.","volume":"61","author":"Hoenigl","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"1","key":"r9","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/OLQ.0000000000000535","article-title":"Are centers for disease control and prevention guidelines for preexposure prophylaxis specific enough? formulation of a personalized HIV risk score for pre-exposure prophylaxis initiation.","volume":"44","author":"Beymer","year":"2017","journal-title":"Sex Transm Dis"},{"issue":"22","key":"r10","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1001\/jama.2019.2591","article-title":"Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force.","volume":"321","author":"Chou","year":"2019","journal-title":"JAMA"},{"issue":"27","key":"r11","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.","volume":"363","author":"Grant","year":"2010","journal-title":"N Engl J Med"},{"issue":"23","key":"r12","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1056\/NEJMoa1506273","article-title":"On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.","volume":"373","author":"Molina","year":"2015","journal-title":"N Engl J Med"},{"issue":"10013","key":"r13","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":"Lancet"},{"doi-asserted-by":"crossref","unstructured":"Meireles P, Plankey M, Rocha M, Rojas J, Brito J, Barros H. Eligibility for pre-exposure prophylaxis according to different guidelines in a cohort of HIV-negative men who have sex with men in Lisbon, Portugal. Sex Res Soc Policy. 2020.","key":"r14","DOI":"10.1007\/s13178-019-00426-9"},{"issue":"5","key":"r15","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/cid\/ciw367","article-title":"Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US cities, 2014.","volume":"63","author":"Hoots","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"3","key":"r16","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/QAD.0000000000001710","article-title":"Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago.","volume":"32","author":"Lancki","year":"2018","journal-title":"AIDS"},{"issue":"4","key":"r17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1097\/QAI.0000000000002042","article-title":"Current US guidelines for prescribing HIV pre-exposure prophylaxis (PrEP) disqualify many women who are at risk and motivated to use PrEP.","volume":"81","author":"Calabrese","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"14","key":"r18","doi-asserted-by":"crossref","first-page":"21091","DOI":"10.2807\/1560-7917.ES2015.20.14.21091","article-title":"Incident risk factors as predictors of HIV seroconversion in the Lisbon cohort of men who have sex with men: first results, 2011-2014.","volume":"20","author":"Meireles","year":"2015","journal-title":"Euro Surveill"},{"issue":"5","key":"r19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-007220","article-title":"The Lisbon Cohort of men who have sex with men.","volume":"5","author":"Meireles","year":"2015","journal-title":"BMJ Open"},{"unstructured":"World Health Organization (WHO). WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection. Module 1: Clinical. Geneva: WHO; 2017. (WHO\/HIV\/2017.17). Available from: https:\/\/www.who.int\/hiv\/pub\/prep\/prep-implementation-tool\/en\/","key":"r20"},{"unstructured":"Centers for Disease Control and Prevention (CDC). US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States\u20142017 Update: a clinical practice guideline. Atlanta: CDC; 2017. Available from: https:\/\/www.cdc.gov\/hiv\/pdf\/risk\/prep\/cdc-hiv-prep-guidelines-2017.pdf","key":"r21"},{"unstructured":"European AIDS Clinical Society (EACS). Guidelines 9.0. Brussels: EACS; 2017. Available from: https:\/\/www.eacsociety.org\/guidelines\/eacs-guidelines\/eacs-guidelines.html","key":"r22"},{"unstructured":"Dire\u00e7\u00e3o-Geral da Sa\u00fade. Norma n\u00b0 025\/2017 de 28\/11\/2017 atualizada a 16\/05\/2018. [Portuguese Directorate-General of Health. Norm No. 025\/2017 of 28\/11\/2017 updated in 16\/05\/2018]. Lisbon: Ministry of Health, 2018. Portuguese. Available from: https:\/\/www.dgs.pt\/directrizes-da-dgs\/normas-e-circulares-normativas\/norma-n-0252017-de-28112017-pdf.aspx","key":"r23"},{"issue":"9","key":"r24","doi-asserted-by":"crossref","first-page":"e402","DOI":"10.1016\/S2352-3018(17)30089-9","article-title":"Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study.","volume":"4","author":"Molina","year":"2017","journal-title":"Lancet HIV"},{"issue":"7","key":"r25","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/00002030-200305020-00012","article-title":"The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam.","volume":"17","author":"Xiridou","year":"2003","journal-title":"AIDS"},{"issue":"1","key":"r26","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/OLQ.0b013e31814fb113","article-title":"Determinants of HIV seroconversion among men who have sex with men living in a low HIV incidence population in the era of highly active antiretroviral therapies.","volume":"35","author":"Lavoie","year":"2008","journal-title":"Sex Transm Dis"},{"issue":"5","key":"r27","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/01.aids.0000216374.61442.55","article-title":"Risk factors for HIV infection among men who have sex with men.","volume":"20","author":"Koblin","year":"2006","journal-title":"AIDS"},{"issue":"10","key":"r28","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/j.1468-1293.2010.00833.x","article-title":"Defining high HIV incidence subgroups of Australian homosexual men: implications for conducting HIV prevention trials in low HIV prevalence settings.","volume":"11","author":"Poynten","year":"2010","journal-title":"HIV Med"},{"issue":"7","key":"r29","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.rce.2019.02.001","article-title":"La implementaci\u00f3n de la profilaxis preexposici\u00f3n podr\u00eda evitar la mayor\u00eda de las nuevas infecciones por el VIH en hombres que tienen sexo con hombres y mujeres transexuales. [Implementing pre-exposure prophylaxis could prevent most new HIV infections in transsexual women and men who have sex with men].","volume":"219","author":"Ayerdi Aguirrebengoa","year":"2019","journal-title":"Rev Clin Esp"},{"issue":"12","key":"r30","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1093\/cid\/ciy370","article-title":"Evaluation of preexposure (PrEP) eligibility criteria, using sexually transmissible infections as markers of human immunodeficiency virus (HIV) risk at enrollment in PrEPX, a large Australian HIV PrEP trial.","volume":"67","author":"Cornelisse","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"10","key":"r31","doi-asserted-by":"crossref","first-page":"e696","DOI":"10.1016\/S2352-3018(19)30139-0","article-title":"Development and validation of an automated HIV prediction algorithm to identify candidates for pre-exposure prophylaxis: a modelling study.","volume":"6","author":"Krakower","year":"2019","journal-title":"Lancet HIV"},{"issue":"7","key":"r32","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1089\/apc.2017.0031","article-title":"Differing experiences with pre-exposure prophylaxis in boston among lesbian, gay, bisexual, and transgender specialists and generalists in primary care: implications for scale-up.","volume":"31","author":"Krakower","year":"2017","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"r33","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S2055-6640(20)30260-0","article-title":"Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. 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