男男性行为者中与 HIV 感染风险较高的性传播感染发生率 - 基于 HIV 暴露前预防的试验和观察性研究数据的荟萃分析。

Incidence of sexually transmitted infections in men who have sex with men and who are at substantial risk of HIV infection - A meta-analysis of data from trials and observational studies of HIV pre-exposure prophylaxis.

机构信息

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venerology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany.

出版信息

PLoS One. 2018 Dec 3;13(12):e0208107. doi: 10.1371/journal.pone.0208107. eCollection 2018.

DOI:10.1371/journal.pone.0208107

PMID:30507962

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6277101/

Abstract

BACKGROUND

Men who have sex with men (MSM) and who engage in condomless anal intercourse with casual partners are at high risk of acquiring sexually transmitted infections (STIs), but reliable epidemiological data are scarce. Studies on HIV pre-exposure prophylaxis (PrEP) enrol MSM who indicate that they engage in behaviour that puts them at high risk of acquiring HIV. Because they also screen for STIs at regular intervals, these studies may serve as a valuable source to estimate incidence rates of STIs in this subpopulation of MSM.

METHODS

We systematically searched for trials and observational studies of PrEP in MSM that reported data on the incidence of STIs during the study period. Incidence rates were calculated as events per 100 person-years (py) with 95% confidence intervals (CI). Data from individual studies were pooled building subgroups along study types and geography. We performed sensitivity analyses, including data only from studies that met pre-defined quality criteria.

RESULTS

Twenty-four publications on 20 studies were included. The majority of studies reported that sexual behaviour and/or STI incidence remained stable or decreased during the study period. For syphilis, incidence rates ranged from 1.8/100py to 14.9/100py, the pooled estimate was 9.1/100py (95%-CI: 7.7-10.9). Incidence rates for gonorrhoea and chlamydia of any site ranged from 13.3/100py to 43.0/100py and 15.1/100py to 48.5/100py, respectively. Considering only studies that met the criteria for sensitivity analysis yielded pooled estimates of 39.6/100py (95%-CI: 32.9-47.6) and 41.8/100py (95%-CI: 33.9-51.5), respectively. The overall estimate for hepatitis C incidence was 1.3/100py (95%-CI: 1.0-1.8).

CONCLUSIONS

Despite partly heterogeneous results, the data depict high incidence rates of STIs among MSM who engage in higher-risk sexual behaviours such as condomless sex with casual partners. This subpopulation of MSM requires access to STI screening at close intervals. By offering access to structures that provide regular STI monitoring and prompt treatment, PrEP may not only decrease HIV incidence but also have beneficial effects in decreasing the burden of STIs.

摘要

背景

男男性行为者（MSM）与偶然伴侣发生无保护肛交性行为，感染性传播感染（STI）的风险很高，但可靠的流行病学数据却很少。针对 HIV 暴露前预防（PrEP）的研究招募了表示存在感染 HIV 高风险行为的 MSM 人群。由于他们还定期接受 STI 筛查，因此这些研究可能是估计 MSM 这一亚人群 STI 发病率的有价值来源。

方法

我们系统地检索了 MSM 中 PrEP 的临床试验和观察性研究，这些研究报告了研究期间 STI 的发病率数据。发病率以每 100 人年（py）的事件数计算，置信区间（CI）为 95%。根据研究类型和地理位置对来自各个研究的数据进行了汇总。我们进行了敏感性分析，仅纳入了符合预先确定的质量标准的研究的数据。

结果

纳入了 24 篇出版物和 20 项研究。大多数研究报告称，在研究期间性行为和/或 STI 发病率保持稳定或下降。梅毒的发病率范围为 1.8/100py 至 14.9/100py，汇总估计值为 9.1/100py（95%CI：7.7-10.9）。任何部位淋病和衣原体的发病率分别为 13.3/100py 至 43.0/100py 和 15.1/100py 至 48.5/100py。仅考虑符合敏感性分析标准的研究，淋病和衣原体的汇总估计值分别为 39.6/100py（95%CI：32.9-47.6）和 41.8/100py（95%CI：33.9-51.5）。丙型肝炎发病率的总估计值为 1.3/100py（95%CI：1.0-1.8）。