Oldenburg Catherine E, Jain Sachin, Mayer Kenneth H, Mimiaga Matthew J
Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; The Fenway Institute, Fenway Community Health, Boston, MA, United States.
The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Drug Alcohol Depend. 2015 Jan 1;146:75-80. doi: 10.1016/j.drugalcdep.2014.11.010. Epub 2014 Nov 26.
Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users.
Retrospective cohort study of all PEP prescriptions (N=1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once.
Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64).
While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.
与男性发生性关系的男性（MSM）中，使用冰毒（CM）者感染艾滋病毒的风险增加。暴露后预防（PEP）是一种有效的艾滋病毒预防策略，前提是个体能够识别高风险暴露并及时就医，然而，迄今为止，关于CM使用者使用PEP的数据有限。
方法A：对马萨诸塞州波士顿芬威社区健康中心的所有PEP处方（788名MSM中的1130份处方）进行回顾性队列研究。多变量模型用于评估暴露期间使用CM（7.4%在暴露期间使用CM）和长期使用CM（7.4%的MSM为长期CM使用者）与至少使用过一次PEP的MSM个体水平和事件水平结局之间的关联。
与未使用CM的人相比，更频繁使用CM的MSM PEP使用者更有可能返回接受重复PEP（调整后比值比[aOR]5.13，95%置信区间[CI]2.82至9.34），并且在随访期间血清转化的可能性显著更高（调整后风险比[aHR]3.61，95%CI 1.51至8.60）。使用CM的MSM作为暴露源进行无保护肛交的几率增加（aOR 2.12，95%CI 1.16至3.87），且知道其性伴侣感染艾滋病毒的几率增加（aOR 2.27，95%CI 1.42至3.64）。
虽然一般而言，使用CM的MSM在获取抗逆转录病毒治疗（ART）方面可能存在挑战，但这些数据突出了一个事实，即那些能够获得PEP的人随后艾滋病毒血清转化的风险仍然增加。对于使用CM的MSM，应考虑在PEP疗程期间进行咨询和/或物质使用干预。
