Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV.
Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV.
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DOI：
10.1097/qad.0000000000001718
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发表时间：
2018-02-20
期刊：
影响因子：
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通讯作者：
Thomas R
中科院分区：
文献类型：
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作者：
Nguyen VK;Greenwald ZR;Trottier H;Cadieux M;Goyette A;Beauchemin M;Charest L;Longpré D;Lavoie S;Tossa HG;Thomas R
使用暴露前预防（PrEP）的艾滋病毒引起了人们对性传播感染（STI）发病率的关注，因为减少了安全套的使用在男男性行为者。这项研究检查了PrEP处方后12个月相对于PrEP前12个月是否与STI相关，以及PrEP使用者相对于接受暴露后预防（PEP）的个人的STI率是否更高。回顾性队列研究，包括PrEP处方前随访超过12个月的PrEP使用者和2010年至2015年在Clinique l 'Actuel（加拿大蒙特利尔）接受PEP的个人。比较PrEP前后12个月内衣原体、淋病、梅毒和丙型肝炎病毒的发病率;使用泊松模型生成PrEP与PEP使用者的发病率比（IRR），95%置信区间（CI）和调整后的IRR（aIRR），控制STI筛查访视的频率。比较PrEP和PEP用户的模型进一步调整了年龄和教育。其中包括109名PrEP和86名PEP用户。在PrEP后12个月内观察到STI发生率相对于前12个月增加（IRR：1.72，CI：1.22-2.41; aIRR：1.39，CI 0.98-1.96）。与PEP使用者相比，PrEP使用者的STI风险也更高（IRR：2.18，CI：1.46-3.24; aIRR：1.76，CI：1.14-2.71）。开始PrEP后，个人性传播感染率的增加可能表明在PrEP的第一年内有更大的风险行为。需要进一步研究来衡量开始PrEP后性传播感染的长期趋势。
Use of preexposure prophylaxis (PrEP) for HIV raises concerns about sexually transmitted infection (STI) incidence because of decreased condom use among MSM. This study examines whether PrEP is associated with STIs in the 12 months following PrEP prescription relative to the 12 months prior to PrEP and if STI rates are higher among PrEP users relative to individuals receiving postexposure prophylaxis (PEP). Retrospective cohort study including PrEP users with more than 12 months of follow-up before PrEP prescription and individuals receiving PEP from 2010 to 2015 at Clinique l’Actuel (Montréal, Canada). Incidence of chlamydia, gonorrhoea, syphilis and hepatitis C virus over 12 months was compared before and after PrEP; and for PrEP versus PEP users using Poisson models to generate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and adjusted IRRs (aIRRs) controlling for frequency of STI-screening visits. Models comparing PrEP and PEP users were further adjusted for age and education. One hundred and nine PrEP and 86 PEP users were included. Increased rates of STIs were observed in the 12 months after PrEP relative to the 12 months prior (IRR: 1.72, CI: 1.22–2.41; aIRR: 1.39, CI 0.98–1.96). PrEP users were also at higher STI risk relative to PEP users (IRR: 2.18, CI: 1.46–3.24; aIRR: 1.76, CI: 1.14–2.71). Increased rates of STIs among individuals after initiation of PrEP may suggest greater risk behaviours during the first year on PrEP. Further studies are needed to measure long-term trends in STI acquisition following PrEP initiation.