Taking pre-exposure prophylaxis does not appear to lower the quality of life for people at risk of contracting HIV.
Pre-exposure prophylaxis (PrEP) has been a game changer for people at risk of contracting HIV, particularly men who have sex with men (MSM). The medication, which combines tenofovir and emtricitabine in the form of a single pill to be taken daily, reduces the chance of transmission significantly.
However, investigators have questioned whether PrEP affects the quality of life of its users in the same way the burden of antiretroviral therapy can impact the quality of life of people living with HIV. The results of a recent study published in PLOS ONE show relatively high quality of life scores that rival those of the general population and barely budged during 48 weeks on PrEP.
Investigators at Weill Cornell Medicine in New York, the Fred Hutchinson Cancer Research Center in Seattle, and other centers reviewed data from 591 participants (186 women and 405 men) enrolled in an existing study comparing 3 different PrEP regimens with the standard tenofovir/emtricitabine combination (the control group). All participants completed a baseline quality of life assessment measured with the EQ-5D-3L, which covers questions on self care, mobility and movement, pain, anxiety, and depression.
The participants were then followed for 48 weeks, with quality of life measurements taken every 8 weeks, and their responses were assigned a number from 0.0 to 1.0. Of the women, 62% stayed on their PrEP regimens for the entire 48 weeks; 69% of the men did the same.
The results for this somewhat reduced original group showed almost no change in quality of life from baseline to week 48. For women, the average score at the beginning of the study was 0.91; after 48 weeks on PrEP it was 0.89. For men, the mean score pre-PrEP was 0.95, with an average of 0.94 after 48 weeks of taking PrEP. This held true regardless of which of the 4 regimens participants took.
“Our findings show that [quality of life] as a global construct is not impacted by PrEP administration, a message important for both clinicians and at-risk individuals,” the investigators wrote in their report, adding that their study is the first to demonstrate this. “Also, this finding may have implications for cost-effectiveness evaluation of PrEP regimens that include health utility as an outcome.”
High quality of life scores were linked with the ability to stay on PrEP and take it as directed. In women, younger age was associated with higher quality of life scores, but the same was not true of men.
The investigators noted that specific questions on sexual wellness and HIV-related anxiety, which could be affected by taking PrEP, were not part of the assessment. Also, the participants not in the control group had to take 3 pills per day as opposed to 1, which also might alter results.
“Missing observations from participants who did not appear for study follow-up may be different from those that remained in follow-up,” the investigators wrote. “Per the design of [the original study], at-risk heterosexual men were not included in the study; and a low number of transgender participants precluded analysis of that subgroup.”