Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
J Int AIDS Soc. 2019 Oct;22(10):e25407. doi: 10.1002/jia2.25407.
INTRODUCTION: Pre-Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event-driven PrEP in Belgium. METHODS: An open-label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropical Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event-driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri-monthly visits. Data were collected on an electronic case report form, web-based diary and self-administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed. RESULTS: Two hundred MSM were followed up for a total duration of 318 person-years. At month 18, 75.4% of the participants were on daily and 24.6% were on event-driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow-up period was 91.5% for all participants, 96.5% for daily and 67.0% for event-driven PrEP use. The number of casual and anonymous sex partners was significantly higher for daily users, as compared with event-driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow-up, for both daily and event-driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow-up. The incidence of bacterial STIs was 75.4 per 100 person-years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person-years. CONCLUSIONS: PrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event-driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure.
简介：暴露前预防（PrEP）在降低男男性行为者（MSM）感染 HIV 的风险方面非常有效，可能对减缓 HIV 流行产生重要影响。然而，人们仍然对低依从性、增加的风险行为以及使用 PrEP 时减少使用避孕套表示担忧。本研究旨在前瞻性评估比利时 MSM 使用每日和事件驱动 PrEP 的这些因素。
方法：这是一项从 2017 年 10 月至 2018 年 5 月在比利时安特卫普热带医学研究所进行的开放性前瞻性队列研究。在登记时，HIV 高危 MSM 在每日或事件驱动 PrEP 之间进行选择。他们在每三个月的就诊时都可以切换方案或停止服用 PrEP。数据通过电子病例报告表、基于网络的日记和自我管理问卷收集。还对 HIV 和其他性传播感染（STI）进行了筛查。
结果：200 名 MSM 共随访 318 人年。在第 18 个月时，75.4%的参与者服用每日 PrEP，24.6%的参与者服用事件驱动 PrEP。在整个随访期间，所有参与者 PrEP 覆盖的性行为比例平均为 91.5%，每日 PrEP 为 96.5%，事件驱动 PrEP 为 67.0%。与事件驱动使用者相比，每日使用者的偶然和匿名性伴侣数量明显更高，但随着时间的推移并没有变化。相比之下，在整个随访期间，每日和事件驱动 PrEP 使用者与偶然和匿名伴侣发生无保护的接受性肛交的比例平均显著增加（所有 4 种趋势的 p<0.0001）。在随访期间未诊断出新的 HIV 感染。细菌性 STI 的发病率为 75.4 例/100 人年（95%CI 63.8 至 89.1）。我们没有发现淋病奈瑟菌/沙眼衣原体的发病率随时间有显著变化。丙型肝炎的发病率为 2.9 例/100 人年。
结论：在比利时，PrEP 是 MSM 有效且采用良好的 HIV 预防工具。参与者根据自己的需求调整了每日和事件驱动的方案，并能够根据风险暴露情况调整 PrEP 的依从性。
Front Microbiol. 2025-6-20
J Acquir Immune Defic Syndr. 2018-10-1
Zotero 插件
