Gravett Ronnie M, Westfall Andrew O, Overton Edgar T, Kudroff Kachina, Muzny Christina A, Eaton Ellen F
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
Int J STD AIDS. 2020 Feb;31(2):127-135. doi: 10.1177/0956462419886228. Epub 2020 Jan 28.
HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. Highrisk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.
艾滋病病毒暴露前预防（PrEP）能有效预防男男性行为者（MSM）感染艾滋病病毒，但PrEP的使用与性传播感染（STIs）有关。在美国南部腹地，PrEP对男男性行为者性传播感染的影响尚不清楚。我们对美国南部腹地一家PrEP诊所的成年男男性行为者进行了一项回顾性分析，以计算细菌性传播感染（衣原体、淋病和梅毒）的患病率和发病率，并通过将新发的性传播感染与患者报告的结果相联系来确定相关风险因素；2014年至2018年间，139名男男性行为者到该诊所就诊，基线细菌性传播感染患病率为11%。在81名符合条件且正在接受PrEP的男男性行为者中，有26人新发了性传播感染，发病率为每100人年33.1例。在新发性传播感染的人群中，PrEP高依从性、多个性伴侣和不坚持使用避孕套的比例明显更高，我们确定PrEP高依从性且有多个性伴侣的男男性行为者感染细菌性传播感染的风险尤其高（风险比：7.57，95%置信区间：1.75 - 32.74）。在该诊所开始使用PrEP后，细菌性传播感染很常见，报告PrEP高依从性和多个性伴侣的男男性行为者发生新发性传播感染的风险很大。开始使用PrEP后，高危性行为依然存在，这凸显了持续、强化的性健康筛查和干预的重要性。
