Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial.
Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial.
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DOI：
10.1007/s10461-010-9712-1
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发表时间：
2010-10
影响因子：
4.4
通讯作者：
Coates, Thomas
中科院分区：
文献类型：
--
作者：
Donnell, Deborah;Mimiaga, Matthew J.;Mayer, Kenneth;Chesney, Margaret;Koblin, Beryl;Coates, Thomas
非职业性暴露后预防（nPEP）是一种艾滋病毒预防策略，自1997年以来，CDC一直建议在高风险性暴露后预防艾滋病毒感染。在对4,295名MSM进行的行为干预试验中，我们评估了美国六个城市4年来对nPEP的看法和使用情况。总体而言，1.9%的MSM在入组前报告使用nPEP，6.3%在试验期间至少使用一次。47.5%的人报告了对nPEP的认识，在两个有资助的nPEP项目的地点，认识更高。在报告nPEP过程的384次访视中发生了3次血清转换，在该队列中nPEP对HIV感染风险无影响（风险比= 0.91，95%置信区间[0.29，2.86]）。NPEP使用者是一个风险较高的群体：观察到与多个伴侣以及与艾滋病毒感染伴侣和艾滋病毒状况未知的伴侣进行无保护的接受性和插入性肛交相关的NPEP使用几率增加。NPEP的使用也与非法药物（注射药物，快克可卡因，致幻剂和安非他明）的使用有关。重要的是，在高风险性行为后愿意使用nPEP与高风险性行为的几率较低相关。在使用nPEP一段时间后，nPEP使用者仍然比该队列中以前未使用过nPEP的人更有可能报告高风险性行为。然而，在先前报告过高风险性行为的人群中，先前使用nPEP与高风险性行为的几率无关，从而减轻了人们对nPEP的可用性将导致高风险性行为增加的担忧。
Non-occupational post-exposure prophylaxis (nPEP) use is an HIV prevention strategy that has been recommended by the CDC to prevent HIV infection after a high risk sexual exposure since 1997. In a behavioral intervention trial of 4,295 MSM we assessed perceptions and use of nPEP over 4 years in six cities across the United States. Overall, 1.9% of MSM reported use of nPEP prior to enrollment, and 6.3% at least once during the trial. Awareness of nPEP was reported by 47.5%, with higher awareness in two sites with funded nPEP programs. Three seroconversions occurred in the 384 visits where nPEP courses were reported, with no effect of nPEP on risk of HIV acquisition in this cohort (hazard ratio = 0.91, 95% confidence interval [0.29, 2.86]). NPEP users were a riskier group: increased odds of nPEP use were observed in association with multiple partners and unprotected receptive and insertive anal sex with HIV infected partners and partners with unknown HIV status. NPEP use was also associated with use of illicit drugs (injection drugs, crack cocaine, hallucinogens, and amphetamines). Importantly, willingness to use nPEP after high risk sex was associated with lower odds of high risk sex. After an episode of nPEP use, nPEP users remained more likely to report high risk sex than those in this cohort who had not previously used nPEP. However, within the subset of people who had previously reported high risk sex, previous nPEP use was not associated with higher odds of high risk sex, thus allaying fears that availability of nPEP would lead to an increase in high risk sex.
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