Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men
Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV...
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| creator | Jenness, Samuel M Sharma, Akshay Goodreau, Steven M Rosenberg, Eli S Weiss, Kevin M Hoover, Karen W Smith, Dawn K Sullivan, Patrick |
| description | Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV transmission at the population and individual levels.
Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk.
When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence.
RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms. |
| doi_str_mv | 10.1371/journal.pone.0169484 |
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Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk.
When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence.
RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0169484</identifier><identifier>PMID: 28060881</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; AIDS ; Analysis ; Anti-HIV Agents - therapeutic use ; Biology and Life Sciences ; Compensation ; Computer simulation ; Condoms ; Disease prevention ; Disease transmission ; Epidemiology ; Gays & lesbians ; Health aspects ; Health risks ; Heterogeneity ; HIV ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; HIV Infections - transmission ; HIV Infections - virology ; Homosexuality, Male ; Human immunodeficiency virus ; Humans ; Incidence ; Infections ; Lentivirus ; Male ; Mathematical models ; Medicine and Health Sciences ; Men ; Mens health ; Models, Statistical ; MSM (Men who have sex with men) ; People and Places ; Pre-Exposure Prophylaxis - methods ; Prevention ; Prophylaxis ; Retroviridae ; Risk ; Risk Assessment ; Risk factors ; Risk taking ; Scaling ; Sex ; Sexual behavior ; Sexual Partners ; Sexually transmitted diseases ; STD ; Stochasticity ; United States - epidemiology ; Unsafe Sex</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0169484-e0169484</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-77f64afb3cf3bd33fb77539f9552afe7efbc1de94b204eb6057d59992c42a9713</citedby><cites>FETCH-LOGICAL-c725t-77f64afb3cf3bd33fb77539f9552afe7efbc1de94b204eb6057d59992c42a9713</cites><orcidid>0000-0001-8840-105X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218403/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218403/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28060881$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jenness, Samuel M</creatorcontrib><creatorcontrib>Sharma, Akshay</creatorcontrib><creatorcontrib>Goodreau, Steven M</creatorcontrib><creatorcontrib>Rosenberg, Eli S</creatorcontrib><creatorcontrib>Weiss, Kevin M</creatorcontrib><creatorcontrib>Hoover, Karen W</creatorcontrib><creatorcontrib>Smith, Dawn K</creatorcontrib><creatorcontrib>Sullivan, Patrick</creatorcontrib><title>Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV transmission at the population and individual levels.
Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk.
When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence.
RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms.</description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Biology and Life Sciences</subject><subject>Compensation</subject><subject>Computer simulation</subject><subject>Condoms</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Epidemiology</subject><subject>Gays & lesbians</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Heterogeneity</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - transmission</subject><subject>HIV Infections - virology</subject><subject>Homosexuality, Male</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infections</subject><subject>Lentivirus</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medicine and Health Sciences</subject><subject>Men</subject><subject>Mens health</subject><subject>Models, Statistical</subject><subject>MSM (Men who have sex with men)</subject><subject>People and Places</subject><subject>Pre-Exposure Prophylaxis - methods</subject><subject>Prevention</subject><subject>Prophylaxis</subject><subject>Retroviridae</subject><subject>Risk</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>Risk taking</subject><subject>Scaling</subject><subject>Sex</subject><subject>Sexual behavior</subject><subject>Sexual Partners</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Stochasticity</subject><subject>United States - epidemiology</subject><subject>Unsafe Sex</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99u0zAUxiMEYmPwBggiISG4aPG_2MnNpGkCGmlo0wbj0nKS49YliYOdlO4leGbcNZtatIvJF7aOf99n-xyfKHqN0RRTgT8t7eBaVU8728IUYZ6xlD2JDnFGyYQTRJ_urA-iF94vEUpoyvnz6ICkiKM0xYfR37ytzMpUg6rjWX4dXxr_K16B84OPL2w31Ko3to3zplNlH1u9BU5t00Hrt3tK9-BuxRcOYN1ZPzgIa9stbmq1Nj7OW9ObEW5sO4-_QRv_XNh4plYQX8E6_mP6xSb6MnqmVe3h1TgfRT--fP5-OpucnX_NT0_OJqUgST8RQnOmdEFLTYuKUl0IkdBMZ0lClAYBuihxBRkrCGJQcJSIKsmyjJSMqExgehS93fp2tfVyTKWXOE04JilnIhD5lqisWsrOmUa5G2mVkbcB6-ZSud6UNUjFq4IVGEOKKkaJKDgkTDAgCaOgMAtex-NpQ9FAVULbO1Xvme7vtGYh53YlE4JThmgw-DAaOPt7AN_LxvgS6lq1YIfbe4fy8yzjj0F5kmaEpwF99x_6cCJGaq7CW02rbbhiuTGVJ0xwgTGim2OnD1BhVNCYMnxRbUJ8T_BxTxCYHtb9XA3ey_zq8vHs-fU--36HXYCq-4W39bD5fX4fZFuwdNZ7B_q-HhjJTYfdZUNuOkyOHRZkb3ZreS-6ayn6D6JCITY</recordid><startdate>20170106</startdate><enddate>20170106</enddate><creator>Jenness, Samuel M</creator><creator>Sharma, Akshay</creator><creator>Goodreau, Steven M</creator><creator>Rosenberg, Eli S</creator><creator>Weiss, Kevin M</creator><creator>Hoover, Karen W</creator><creator>Smith, Dawn K</creator><creator>Sullivan, Patrick</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-8840-105X</orcidid></search><sort><creationdate>20170106</creationdate><title>Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men</title><author>Jenness, Samuel M ; Sharma, Akshay ; Goodreau, Steven M ; Rosenberg, Eli S ; Weiss, Kevin M ; Hoover, Karen W ; Smith, Dawn K ; Sullivan, Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-77f64afb3cf3bd33fb77539f9552afe7efbc1de94b204eb6057d59992c42a9713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>AIDS</topic><topic>Analysis</topic><topic>Anti-HIV Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jenness, Samuel M</au><au>Sharma, Akshay</au><au>Goodreau, Steven M</au><au>Rosenberg, Eli S</au><au>Weiss, Kevin M</au><au>Hoover, Karen W</au><au>Smith, Dawn K</au><au>Sullivan, Patrick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-06</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0169484</spage><epage>e0169484</epage><pages>e0169484-e0169484</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV transmission at the population and individual levels.
Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk.
When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence.
RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28060881</pmid><doi>10.1371/journal.pone.0169484</doi><tpages>e0169484</tpages><orcidid>https://orcid.org/0000-0001-8840-105X</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | MEDLINE; NCBI_PubMed Central（免费）; Public Library of Science; Full-Text Journals in Chemistry (Open access); DOAJ Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Acquired immune deficiency syndrome AIDS Analysis Anti-HIV Agents - therapeutic use Biology and Life Sciences Compensation Computer simulation Condoms Disease prevention Disease transmission Epidemiology Gays & lesbians Health aspects Health risks Heterogeneity HIV HIV Infections - epidemiology HIV Infections - prevention & control HIV Infections - transmission HIV Infections - virology Homosexuality, Male Human immunodeficiency virus Humans Incidence Infections Lentivirus Male Mathematical models Medicine and Health Sciences Men Mens health Models, Statistical MSM (Men who have sex with men) People and Places Pre-Exposure Prophylaxis - methods Prevention Prophylaxis Retroviridae Risk Risk Assessment Risk factors Risk taking Scaling Sex Sexual behavior Sexual Partners Sexually transmitted diseases STD Stochasticity United States - epidemiology Unsafe Sex |
| title | Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T18%3A17%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Individual%20HIV%20Risk%20versus%20Population%20Impact%20of%20Risk%20Compensation%20after%20HIV%20Preexposure%20Prophylaxis%20Initiation%20among%20Men%20Who%20Have%20Sex%20with%20Men&rft.jtitle=PloS%20one&rft.au=Jenness,%20Samuel%20M&rft.date=2017-01-06&rft.volume=12&rft.issue=1&rft.spage=e0169484&rft.epage=e0169484&rft.pages=e0169484-e0169484&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0169484&rft_dat=%3Cgale_plos_%3EA476711036%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1856128647&rft_id=info:pmid/28060881&rft_galeid=A476711036&rft_doaj_id=oai_doaj_org_article_a6db4b11e80d4327b6e5474e2543ea14&rfr_iscdi=true |