No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis.
No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis.
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DOI：
10.1371/journal.pone.0081997
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Grant RM
中科院分区：
文献类型：
--
作者：
Marcus JL;Glidden DV;Mayer KH;Liu AY;Buchbinder SP;Amico KR;McMahan V;Kallas EG;Montoya-Herrera O;Pilotto J;Grant RM
在iPrEx试验中，恩曲他滨/富马酸替诺福韦酯（FTC/TDF）暴露前预防（PrEP）减少了与男性发生性关系的男性和变性女性的HIV感染。自我报告的性风险行为总体下降，但可能受到报告偏见的影响。我们使用性风险行为的生物标志物来评估潜在的风险补偿。在基线和此后每季度评估性行为;在12周时评估感知的治疗分配和PrEP疗效信念。在有≥1次随访行为评估的参与者中，通过感知治疗分配、实际治疗分配和感知PrEP疗效比较性行为、梅毒和HIV感染。总体而言，急性HIV感染和梅毒在随访期间减少。与相信他们正在接受安慰剂的参与者相比，相信他们正在接受FTC/TDF的参与者在开始药物治疗前报告了更容易接受的肛交伴侣（12.8 vs. 7.7，P = 0.04）。 接受FTC/TDF的信念与从基线到随访期间无避孕套的接受性肛交（ncRAI）增加无关（风险比[RR] 0.9，95%置信区间[CI]：0.6-1.4; P = 0.75），也与停用研究药物后的减少无关（RR 0.8，95% CI：0.5-1.3; P = 0.46）。 在安慰剂组中，认为接受FTC/TDF治疗（发病率比[IRR] 0.8，95% CI：0.4-1.8; P = 0.26）和认为其高度有效（IRR 0.5，95% CI：0.1-1.7; P = 0.12）的受试者的HIV发病率有降低的趋势。 在iPrEx中没有性风险补偿的证据。认为他们正在接受FTC/TDF的参与者在开始药物治疗之前有更多的伴侣，这表明风险行为不是PrEP使用的结果。
Preexposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) reduced HIV acquisition in the iPrEx trial among men who have sex with men and transgender women. Self-reported sexual risk behavior decreased overall, but may be affected by reporting bias. We evaluated potential risk compensation using biomarkers of sexual risk behavior. Sexual practices were assessed at baseline and quarterly thereafter; perceived treatment assignment and PrEP efficacy beliefs were assessed at 12 weeks. Among participants with ≥1 follow-up behavioral assessment, sexual behavior, syphilis, and HIV infection were compared by perceived treatment assignment, actual treatment assignment, and perceived PrEP efficacy. Overall, acute HIV infection and syphilis decreased during follow-up. Compared with participants believing they were receiving placebo, participants believing they were receiving FTC/TDF reported more receptive anal intercourse partners prior to initiating drug (12.8 vs. 7.7, P = 0.04). Belief in receiving FTC/TDF was not associated with an increase in receptive anal intercourse with no condom (ncRAI) from baseline through follow-up (risk ratio [RR] 0.9, 95% confidence interval [CI]: 0.6–1.4; P = 0.75), nor with a decrease after stopping study drug (RR 0.8, 95% CI: 0.5–1.3; P = 0.46). In the placebo arm, there were trends toward lower HIV incidence among participants believing they were receiving FTC/TDF (incidence rate ratio [IRR] 0.8, 95% CI: 0.4–1.8; P = 0.26) and also believing it was highly effective (IRR 0.5, 95% CI: 0.1–1.7; P = 0.12). There was no evidence of sexual risk compensation in iPrEx. Participants believing they were receiving FTC/TDF had more partners prior to initiating drug, suggesting that risk behavior was not a consequence of PrEP use.
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