Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 25.
doi: 10.1007/s15010-025-02667-w. Online ahead of print.

Five-Year German PrEP cohort reveals high HIV protection and persistent STI burden: implications for individualized and flexible prevention strategies

Maher Almahfoud  1   2 , Lukas Weimann  3 , Guido Schäfer  4 , Till Koch  5   6 , Hanna Matthews  3 , Hanna-Marie Weichel  7 , Friederike Hunstig  3 , Marc Grenz  8 , Robin L Scheiter  9 , Marylyn M Addo  10   3   5 , Julian Schulze Zur Wiesch  10   3   5 , Olaf Degen  3
Affiliations

Five-Year German PrEP cohort reveals high HIV protection and persistent STI burden: implications for individualized and flexible prevention strategies

Maher Almahfoud et al. Infection. .

Abstract

Purpose: To evaluate adherence patterns, effectiveness, and sexually transmitted infection (STI) incidence among pre-exposure prophylaxis (PrEP) users in Germany and identify strategies to optimize HIV and STI prevention through individualized care and alternative PrEP modalities.

Methods: A single-site, pseudonymized prospective cohort study was conducted in Hamburg, Germany from December 2019 to September 2024. Clinical and laboratory data were linked with structured behavioral surveys from PrEP users at the University Medical Center Hamburg-Eppendorf.

Results: Of 980 consented individuals, 589 initiated PrEP (median age 32 years, 97.1% male, and 81.8% were born in Germany). The mean follow-up was 102.3 weeks (IQR: 38.6-151.4), totaling 1189.5 person-years. Daily users averaged 315 days of PrEP coverage per year (IQR: 293.0-361.9 days), whereas on-demand users averaged 219 days (IQR: 138.4-311.6 days), highlighting substantial variability in usage patterns. The overall dropout rate was 46.9%. No cases of HIV occurred during active PrEP use. STI incidence remained high 52.4 /100 PY (95% CI: 47.8-57.4, n = 421) for daily PrEP users, 38.9/100 PY (95% CI: 30.1-49.5, n = 79) for event-driven users, predominantly due to Chlamydia trachomatis (21.1/100 PY) and Neisseria gonorrhoeae (18.8/100 PY). Interest in long-acting PrEP was high (70%), especially among illicit substance users (OR 5.54). Renal function remained stable during follow-up.

Conclusion: PrEP demonstrated high effectiveness despite heterogeneous risk burden and generally stable renal function. This supports flexible, person-centered models with simplified, risk-stratified monitoring and long-acting options. To extend impact beyond MSM, services should add multilingual access and women- and migrant-inclusive outreach.

Keywords: Chemsex; HIV prevention; Pre-exposure prophylaxis; Real-world cohort study; Sexually transmitted infections; Substance use.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. This study was approved by the University of Hamburg and the responsible local ethics committee of Hamburg. Consent to participate: Written informed consent was obtained from all participants included in the study. All participants were informed about the publication of anonymized data. No person-related data were published.

References

    1. WHO (2022) Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030
    1. Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14:820–9. https://doi.org/10.1016/S1473-3099(14)70847-3 . - DOI - PubMed - PMC
    1. WHO (2012) Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV
    1. [DAIG] Deutsche AIDS-Gesellschaft [ÖAG] Österreichische AIDS Gesellschaft Deutsch-Österreichische Leitlinien zur HIV-Präexpositionsprophylaxe-Klassifikation: S2k. AWMF-Register-Nr.: 055–008
    1. European Medicines Agency (2016) First medicine for HIV pre-exposure prophylaxis recommended for approval in the EU: Truvada to enhance existing HIV prevention strategies

LinkOut - more resources