SUPER excited for this panel this AM! Stay tuned for updates on Doxy PEP!! #STDConf22 Image
Amazing results with Doxy PEP, 65% reduction in STIs per quarter, 55-57% reduction in GC, 74-88% reduction in CT, and 87% reduction in syphilis (only significant among PrEP but not much baseline syphilis) ImageImageImageImage
Participants typically took 16 doses per month based on pill count, majority took <10 doses/month. No change in sex partners, condoles sex, or risk compensation. Image
Gonococcal Tetracycline susceptibility - baseline 25% TCN resistance, but still saw results which is interesting. Still would resistance increase with more Doxy PEP use?? More research needed Image
Now how will Doxy PEP affect the microbiome??
MSM who have receptive anal sex have enriched Prevotella microbiome, lube also affects microbiome.
Not many studies on Doxycycline and its effect on microbiome ImageImage
What about antimicrobial resistance?? We know gonorrhea has developed resistance to everything we have thrown at it, with azithromycin serving as a cautionary tale ImageImage
Doxycycline is important for chalmydia, syphilis, and Mycoplasma genitalium, with resistance needing to be followed closely.
Not much data on chlamydia and syphilis resistance, theoretical potential of syphilis resistance to doxy but still primary non-betalactam
As for Mycoplasma genitalium, 11% in Ipergay had Mgen, we know there are high rates of resistance to macrocodes and increasing to quinolone, with doxycycline being the alternative, something to definitely keep in the back of our minds and again need more data for all of these Image
And lest we not forget, doxycycline is effective against Staph aureus, and increased use can increase resistance to Staph aureus (subclinical resistance present) Image
Now for implementation:
We still don't know the best way to implement currently with pros and cons for broader and more restrictive use
Counseling points included below but also need to discuss risk of AMR and side effects ImageImageImage
Other implementation considerations:
Doxycycline is affordable out of pocket!
Lab monitoring is more difficult (as always) - consider CBC, renal, and liver function test monitoring periodically (every 6 months? annually?)
STI screening every 3-6 months? ImageImage
DoxyPEP should most definitely be integrated in HIV PrEP and HIV ART services!! Image
So overall DoxyPEP is a game changer! It allows us to meet our patients where they are at! It has great effect! It is affordable! It is user friendly! But also we need to monitor antimicrobial resistance for sure and see who this may most benefit focusing on equity and dec stigma

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More from @JncherabieMD

Mar 5
DoxyPEP implications for antimicrobial resistance next. Methods of development of tetracycline resistance are effluent pumps, enzymatic inactivation, ribosomal protection, or single mutation in 16s rRNA. Most commonly it is the tet gene, esp in NG
Just fyi, Chlamydia trachomatis and Treponema pallidum are not inherently resistant to tetracycline. However Chlamydia suis in pigs can be resistant, and can transmit its method of resistance to CT. Brachyspira hyodysenteria in pics can also be resistant and transmit to TP
Bacteria with acquired resistance to tetracycline is NG, There is also concern that we may select resistance to 3rd generation cephalosporins under DoxyPEP, however a study showed no association between TCN and ceftriaxone resistance. There is continued monitoring though
Read 5 tweets
Mar 4
Updates on HIV and STI prevention!! So excited!! First up, Phase 1 annual TAF implants in cisgender women - CAPRISA Trial #CROI2024
Group 1 - 1 implant, Group 2- 1 or 2 implants (up to 48 weeks)
No serious adverse events
Induration, hyperpigmentation, and tenderness most common
11 (31%) early removals in the study, with 2 having had an abscess
Plasma TAF concentration detected in 77% of samples
There was poor tolerability overall though with lower than planned drug release. Gonna need higher drug release and lower site reactions
ANRS 174 DOXYVAC trial next!
Reminder DOXYPEP is effective with Men B vaccine associated with reduction in NG infections (hopefully)
Adjusted Hazard Ratio 0.17 for DoxyPEP (83% reduction)
HR 0.14 CT, 0.21 Syphilis
Reduction of Gonorrhea with DoxyPEP HR 0.67
All significant
Read 10 tweets
Jul 30, 2022
#AIDS2022 Plenary Session on HIV in Indigenous Cultures in Canada
Stigma amongst Indigenous peoples with HIV still prominent, especially in rural areas still play a role, secondary to imposed ideology of Church and colonization
This is a major barrier to reaching 95-95-95 goals
A call for Indigenous People to be included as a Priority Population in the global HIV response, with global commitment to these peoples all around the world, wherever Indigenous People happen to be. #AIDS2022
Converging syndemic of HIV and the opioid epidemic, with COVID-19 exposing the cracks in the system, along with the increasing need to focus on and prioritize mental health during the lockdown has greatly affected Indigenous Peoples #AIDS2022
Read 4 tweets
Jul 30, 2022
Good morning from Day 2 from #AIDS2022, first talk, the possibility of HIV mRNA Vaccine
Difficulties - HIV integrates into DNA, highly mutable, and complex response to HIV envelope glycoprotein
An mRNA vaccine was able to create broadly neutralizing antibodies however much different landscape on surface of HIV compared to SARS-COV-2
mRNA sticks around, is cheap to produce, easily modified, and creates endogenous protein
Of course vaccine equity is v important #AIDS2022
Possibility to Prime, then boost multiple times to create broadly neutralizing Abs, would require multiple clinical trials
IAVI G001 - 2 immunizations of vaccine, low dose and high dose arms, well tolerated, 94-97% response, increased mutation levels on second vaccine #AIDS2022
Read 4 tweets
Jul 29, 2022
Newly released WHO Consolidated Guidelines on HIV, Hepatitis, and STI prevention, diagnosis, treatment, and care for key populations

who.int/news/item/29-0…

#AIDS2022
Essential health interventions recommended below! Image
And newly released UNAIDS Report, highlighting HIV acquisition amongst priority populations Image
Read 5 tweets
Dec 18, 2020
It’s starting!!! Updates to come after the presentation but updates to the CDC STI Guidelines @CDCSTD #IDtwitter Image
The current state of Gonorrhea, Chlamydia, primary and secondary Syphilis, Congenital Syphilis, and the effect of COVID-19 on STI testing ImageImageImage
The roles of clinicians in STI prevention, the purpose of the guidelines as well as the major themes, and the importance of STI vs STD (infection refers to an organism infecting an individual whereas disease refers to a clinical process and as we know many STIs are asymptomatic) ImageImageImageImage
Read 27 tweets

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