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HIV/AIDS
Cohort profile
Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada
  1. Zoë R Greenwald1,
  2. Mathieu Maheu-Giroux2,
  3. Jason Szabo3,
  4. Judith Alexia B Robin3,
  5. Michel Boissonnault1,
  6. Vinh-Kim Nguyen4,
  7. Réjean Thomas3
  1. 1 Epidemiology, Clinique médicale l’Actuel, Montreal, Quebec, Canada
  2. 2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  3. 3 Clinical Department, Clinique médicale l’Actuel, Montreal, Quebec, Canada
  4. 4 Global Health Centre, Institut de Hautes Etudes Internationales et du Developpement, Geneva, Switzerland
  1. Correspondence to Zoë R Greenwald; zoe.greenwald{at}lactuel.ca

Abstract

Purpose The l’Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l’Actuel, a large sexual health clinic located in Montreal, Canada.

Participants Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. The l’Actuel PrEP Cohort contains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America.

Findings to date No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start.

Future plans The l’Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.

  • HIV & AIDS
  • sexual medicine
  • pre-exposure prophylaxis
  • men who have sex with men
  • HIV prevention
  • sexually transmitted infections

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-028768

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    Footnotes

    • Contributors Study concept and design: ZRG, RT. Data acquisition: JS, JABR, MB, V-KN, RT. Data analysis: ZRG. Data interpretation: ZRG, MM-G, V-KN, RT. Drafting of the manuscript: ZRG, MM-G, V-KN. Critical revision of the manuscript for important intellectual content and final approval: ZRG, MM-G, JS, JABR, MB, V-KN, RT.

    • Funding There is no independent funding source for this study. MM-G’s research program is funded by a career award from the Fonds de recherche du Québec—Santé, and grants from the Canadian Foundation for AIDS Research and the Canadian Institutes of Health Research. VKN is supported through the European Research Council Consolidator Grant 617930.

    • Competing interests MM-G reports an investigator-sponsored research grant from Gilead Sciences Inc., contractual arrangements from both the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS), all outside of the submitted work. JS has served as a consultant and member of a scientific advisory board for ViiV, Gilead, Merck and Teva; and received speakers fees from Gilead, Merck and Theratechnologies. RT is a member of advisory boards for AbbVie, Gilead, Merck and ViiV; has received grants/honoraria from AbbVie, Gilead, Merck and ViiV; and has participated in clinical trials with AbbVie, Gilead, Merck, GSK/ViiV and Janssen. VKN has received honoraria from Gilead.

    • Ethics approval Ethics approval was granted by the Veritas Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.

    • Collaborators Clinique l’Actuel welcomes collaborations. Data from the l’Actuel PrEP Cohort on collected measures outlined in Table 3 may be available for research use. Further information about the data can be obtained by contacting the study principal investigator: rejean.thomas@lactuel.ca. For all collaborative work, relevant ethical approval will need to be sought.

    • Patient consent for publication Not required.