Disease Elimination Program, Public Health Discipline, Burnet Institute.
School of Population and Global Health, The University of Melbourne, Victoria, Australia.
Clin Infect Dis. 2018 Aug 16;67(5):676-686. doi: 10.1093/cid/ciy182.
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM.
We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed.
Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.
Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.
人类免疫缺陷病毒（HIV）暴露前预防（PrEP）在降低男男性行为者（MSM）的 HIV 风险方面是有效的。然而，人们仍然担心 PrEP 使用者可能会出现风险补偿，从而导致 condom 使用减少和性传播感染（STI）发病率增加。我们评估了 PrEP 对 MSM 性风险结果的影响。
我们对截至 2017 年 8 月发表的报告了 HIV 阴性 MSM 和跨性别女性在每日口服 PrEP 使用背景下性风险结果的开放标签研究进行了系统评价。使用随机效应荟萃分析计算了汇总效应估计值，并进行了定性评价和风险偏倚评估。
符合选择标准的有 16 项观察性研究和 1 项开放标签试验。8 项研究共 4388 名参与者报告了 STI 流行率，13 项研究共 5008 名参与者报告了 condom 使用变化。PrEP 使用与直肠衣原体感染（比值比 [OR]，1.59；95%置信区间 [CI]，1.19-2.13）和任何 STI 诊断（OR，1.24；95%CI，.99-1.54）的显著增加相关。PrEP 使用与 STI 诊断的相关性在后期研究中更强。大多数研究表明 PrEP 使用者中有更多无 condom 性行为。
研究结果强调了努力减少 PrEP 使用者及其性伴侣中的 STI 的重要性。需要对 PrEP 扩大使用背景下 MSM 中的风险补偿进行监测，以评估 PrEP 对 MSM 性健康的影响，并为预防策略提供信息。
