Rapid HIV pre-exposure prophylaxis (PrEP) initiation is safe and feasible: Experience from Wroclaw All Saints cohort in Poland 2017-2021.

Abstract

Introduction: HIV pre-exposure prophylaxis (PrEP) still faces many barriers around the world. Additional barriers such as retesting or rescheduling for result analysis and prescription might lead to abandoning PrEP initiation altogether. We wanted to explore whether there would be a significant number of alert issues among people starting PrEP that would warrant more in-depth clinical analysis before commencing PrEP safely.

Methods: A retrospective medical data analysis of people who started PrEP at All Saints Clinic in Wroclaw, Poland between October 2017 and January 2021 was performed. Rapid (during the first visit) or delayed PrEP initiation was chosen at the discretion of the attending physician.

Results: A total of 308 people started PrEP in the analysed period and were included in the analysis. The median age was 33 years with 96.75% being men who have sex with men (MSM) and 68.5% opting for daily dosing at PrEP initiation. Most (n=233) started PrEP rapidly (i.e., during the first visit), whereas for 75 individuals the initiation was delayed by a median of 7 days. Logistic regression analysis showed that lack of test laboratory results, recent exposure or age over 50 years were reasons for delaying PrEP initiation. Median creatinine values increased from 0.93 mg/mL to 0.95 mg/mL 1 month after PrEP initiation. Despite being statistically significant (p = 0.0282, 95% CI 0.0015-0.027), the difference was not significant clinically.

Conclusions: Rapid PrEP initiation was feasible and safe while contraindications were rare. HIV infection exclusion before PrEP initiation can be streamlined by utilizing remote consultations and patient self-interpretation of the results. Renal complications are either not clinically significant or occur rarely.