Did Pre-exposure Prophylaxis Roll-Out Influence the Epidemic of Rectal Lymphogranuloma Venereum in Belgium? Results From the National Surveillance System.

BACKGROUND

An increase of lymphogranuloma venereum (LGV) in HIV negative men who have sex with men is reported in several European countries including Belgium before the implementation of pre-exposure prophylaxis (PrEP).

SETTING

The epidemiological characteristics of the male rectal LGV epidemic in Belgium were explored before and after the introduction of PrEP.

METHODS

Segmented regression models were used to examine a change in trends before and after the introduction of PrEP in the male rectal LGV epidemic in Belgium and among men attending a large HIV/sexually transmitted infection clinic in Antwerp, Belgium.

RESULTS

Although an increase of 69% was noted in absolute numbers in 2019 compared with 2018 (140 vs 83 cases) in Belgium, models showed that the rate of increase did not change after the introduction of PrEP. More than half of the cases were found in HIV-negative men (56.2%) in 2019, but no difference in the magnitude of the trend was found after the introduction of PrEP. Nevertheless, the data reveal that a statistical significant increase of LGV prevalence was noted among non-HIV-positive men in an HIV/sexually transmitted infection clinic after the implementation of PrEP. Indeed, LGV prevalence in the Antwerp male PrEP cohort increased from 0.8% in 2017 to 2.4% in 2019.

CONCLUSIONS

The trend of LGV increase did not accelerate after the introduction of PrEP. Continued surveillance in men who have sex with men irrespective of their HIV status is required for the management and control of the LGV epidemic.