Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.
Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.
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DOI：
10.1016/s1473-3099(14)70847-3
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发表时间：
2014-09
期刊：
影响因子：
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通讯作者：
iPrEx study team
中科院分区：
文献类型：
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作者：
Grant RM;Anderson PL;McMahan V;Liu A;Amico KR;Mehrotra M;Hosek S;Mosquera C;Casapia M;Montoya O;Buchbinder S;Veloso VG;Mayer K;Chariyalertsak S;Bekker LG;Kallas EG;Schechter M;Guanira J;Bushman L;Burns DN;Rooney JF;Glidden DV;iPrEx study team
艾滋病毒暴露前预防(PrEP)的影响取决于吸收、坚持和性行为。之前在PrEP试验中登记的与男性发生性关系的男性和变性女性(MSM/TGW)参加了72周的开放标签延期(Iprex OLE)。药物浓度在血浆和血清转化器中的干血点(DBS)以及血清阴性的随机样本中被测量。共招募了1603名HIV非感染者，其中76%的人接受了预防接种。在那些报告无避孕套接受性肛交(ncRAI；P=0.003)和有疱疹血清学证据(P=0.03)的人中，PREP摄取率较高。在接受PrEP治疗的患者中，艾滋病毒发病率为1.8%/100Py，比同时没有选择PrEP的患者低49%(95%CI：−1~74%)，比之前随机阶段的安慰剂组(3.9/100Py)低53%(95%CI：26%~70%)。在接受PrEP治疗的患者中，如果在DBS中没有检测到药物，艾滋病毒发病率为4.7%/100Py，如果药物浓度表明每周使用不到2片药物，艾滋病毒发病率为2.3%/100Py，每周使用2-3片药物的患者为0.6%/100Py，每周使用4片或更多药物的患者为0/100Py(P<；0.0001)。在年龄较大、受教育程度较高、ncRAI、性伴侣较多、跨性别、有梅毒或疱疹病史的人中，预备药物浓度较高。当有经验的提供者免费提供PREP时，PREP的接受率很高。在风险较高的时期，通过更多的吸收和坚持，准备工作的影响会增加；首次使用后退出是常见的。DBS药物浓度与PrEP的保护益处密切相关。
The impact of HIV pre-exposure prophylaxis (PrEP) depends on uptake, adherence, and sexual practices. Men and transgender women who have sex with men (MSM/TGW) previously enrolled in PrEP trials were enrolled in a 72 week open label extension (iPrEx OLE). Drug concentrations were measured in plasma and dried blood spots (DBS) in seroconverters and a random sample of seronegatives. 1603 HIV uninfected persons were enrolled, of whom 76% received PrEP. PrEP uptake was higher among those reporting condomless receptive anal intercourse (ncRAI; P=0.003) and having serological evidence of herpes (P=0.03). Among those receiving PrEP, HIV incidence was 1.8/100PY, which was 49% (95% CI: −1 to 74%) lower than among those who concurrently did not choose PrEP after adjusting for sexual behavior, and 53% (95% CI: 26 to 70%) lower than in the placebo arm of the prior randomized phase (3.9/100PY). Among those receiving PrEP, HIV incidence was 4.7/100PY if drug was not detected in DBS, 2.3/100PY if drug concentrations indicated use of less than 2 tablets per week, 0.6/100PY for use of 2 to 3 tablets per week, and 0/100PY for use of 4 or more tablets per week (P<0.0001). PrEP drug concentrations were higher among people with older age, more schooling, ncRAI, more sexual partners, trans-identification, and a history of syphilis or herpes. PrEP uptake was high when made available free of charge by experienced providers. PrEP impact is increased by greater uptake and adherence during periods of higher risk; disengagement after initial use is common. DBS drug concentrations are strongly correlated with PrEP’s protective benefit.