PrEPped for COVID? Exploring the association between HIV pre-exposure prophylaxis use and COVID-19 experience among MSM

Background Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. Studies are underway to investigate the effectiveness of HIV antiretrovirals, including Tenofovir-based PrEP, for treating and preventing COVID-19. We investigated the association between HIV-PrEP use and COVID-19 among men who have sex with men in the UK. Methods Participants completed an online survey (23/06/20–14/07/20), including men (cis/transgender), transwomen or gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth. The outcome was COVID-19 experience, defined as reporting a positive test (antigen/antibody) or symptoms of a new continuous cough, high temperature or anosmia following the implementation of UK-wide restrictions (‘lockdown’ 23/03/20). All participants reporting taking HIV-PrEP since the beginning of the COVID-19 pandemic (12/19) were compared with those who did not. Analysis was performed using logistic regression, adjusting for sociodemographics (age, ethnicity, education, country) and subsequently for behavioural factors during lockdown (relationship status, chem-sex and number of new partners). Results Altogether, 1,814 (89.9%) participants reported that they were living without HIV, of whom 253 (14.0%) reported experiencing COVID-19 (positive test or symptoms). Since December 2019, 410 (22.6%) participants reported taking HIV-PrEP, with daily use being lower during lockdown (6.2%) compared with the three months pre-lockdown (14.3%). HIV-PrEP use was positively associated with COVID-19 (crude-OR=1.51, 95%CI=1.13–2.04, p=0.006), including after adjusting for sociodemographics (OR=1.57, 95%CI:1.16–2.11, p=0.005), and after further adjustment for behavioural factors (OR=1.51, 95%CI:1.11–2.06, p Conclusion There is a positive association between HIV-PrEP use and COVID-19, independent of number of new partners. Our findings may reflect behaviours that increase COVID-19 exposure amongst HIV-PrEP users that are not captured in our analysis. People may also perceive that HIV-PrEP offers them protection against COVID-19. However, until robust evidence is available, people taking HIV-PrEP should adhere to COVID-19 prevention advice.