Keck School of Medicine, University of Southern California, Los Angeles, CA.
University of California, San Diego, San Diego, CA.
J Acquir Immune Defic Syndr. 2019 Jan 1;80(1):e9-e13. doi: 10.1097/QAI.0000000000001885.
A public health concern regarding HIV pre-exposure prophylaxis (PrEP) is sexual risk compensation (ie, increased unsafe sex among PrEP users that may undermine prevention efforts).
This demonstration study (NCT#01761643; initiated in 2013) included 398 men who have sex with men who initiated PrEP and were followed over 48 weeks at 4 sites in Southern California. Wilcoxon signed-rank tests compared previous 30-day number of sex partners and condomless insertive anal sex and receptive anal sex (CIAS and CRAS, respectively) acts at weeks 4, 12, 24, 36, and 48 to baseline. At 2 sites, PrEP users were also compared with a lagged, comparison group of 99 men who have sex with men who did not receive PrEP over 24 weeks using linear regression models, adjusting for age, race/ethnicity, education, and respective baseline scores. Logistic regression compared week 24 sexually transmitted infection (STI) rates.
Over 48 weeks in the PrEP group, there were significant decreases in the number of unknown HIV status sex partners and increases in CRAS at all study visits; there was no consistent change in number of HIV+ sex partners or CIAS. Among participants at 2 sites, there were no significant differences between PrEP and non-PrEP users in change in number of partners, CIAS, CRAS, or STI rates at week 24.
Among early adopters of PrEP, there is some evidence for sexual risk compensation. Results support current guidelines of regular STI screening and behavioral risk reduction and adherence counseling with the provision of PrEP.
人们对艾滋病毒暴露前预防（PrEP）存在公共卫生方面的担忧，即性风险补偿（即 PrEP 用户中不安全性行为增加，可能破坏预防工作）。
本示范研究（NCT01761643；2013 年启动）纳入了 398 名男男性行为者，他们开始使用 PrEP，并在加利福尼亚州南部的 4 个地点接受了 48 周的随访。Wilcoxon 符号秩检验比较了第 4、12、24、36 和 48 周时的前 30 天性伴侣人数和无保护的插入性肛交（CIAS）和接受性肛交（CRAS）次数，以及基线时的这些数据。在 2 个地点，还通过线性回归模型，对 PrEP 使用者和未接受 PrEP 的 99 名男男性行为者进行了 24 周的滞后比较，调整了年龄、种族/民族、教育程度和各自的基线得分。Logistic 回归比较了第 24 周的性传播感染（STI）率。
在 PrEP 组中，48 周内，HIV 未知状态的性伴侣数量减少，所有研究访视时 CRAS 增加；HIV+性伴侣数量或 CIAS 没有持续变化。在 2 个地点的参与者中，PrEP 使用者和非 PrEP 使用者在第 24 周时的性伴侣数量、CIAS、CRAS 或 STI 率的变化没有显著差异。
在 PrEP 的早期使用者中，有一些证据表明存在性风险补偿。结果支持当前的指南，即定期进行 STI 筛查和行为风险降低，并在提供 PrEP 的同时进行依从性咨询。
