From the Department of Epidemiology, University of Washington, Seattle, WA.
Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Perú.
Sex Transm Dis. 2020 Dec;47(12):825-831. doi: 10.1097/OLQ.0000000000001310.
We assessed sexual behavior and incidence of sexually transmitted infections (STIs) among men who have sex with men and transgender women participating in Sabes, a study of an expanded treatment as prevention strategy focused on early diagnosis and treatment of HIV infection in Lima, Peru (2013-2017).
Sabes participants were tested monthly for HIV to identify acute or early infections, and HIV-positive participants were randomized to receive antiretroviral therapy immediately (immediate arm) or after 24 weeks (deferred arm) during a 48-week follow-up period. Sexual behavior was assessed at randomization (baseline) and every 12 weeks thereafter. Participants were tested for urethral and rectal chlamydia and gonorrhea and for syphilis at baseline, 12, 24, and 48 weeks. We describe patterns of sexual behavior during the 48-week follow-up period and compare sexual behavior and STI incidence between study arms.
After randomization, 207 HIV-positive participants completed questionnaires and STI testing at 2 or more visits. After HIV diagnosis, participants in both arms reported increases in condom use with main and casual partners and decreased drug and alcohol use before or during anal sex. We observed no between-arm differences in sexual behavior. Deferred arm participants had higher incidence of chlamydia (incidence rate ratio, 2.33; 95% confidence interval, 1.14-4.77) but not gonorrhea or syphilis.
Despite reported increases in condom use, the overall high incidence of STIs reflects some ongoing condomless sex among HIV-positive men who have sex with men and transgender women, highlighting the importance of regular STI screening and counseling to support consistent condom use among HIV-positive individuals at risk for STIs.
我们评估了参与 Sabes 研究的男男性行为者和跨性别女性的性行为和性传播感染（STI）发生率，该研究是在秘鲁利马开展的一项扩大治疗即预防策略研究，侧重于 HIV 感染的早期诊断和治疗（2013-2017 年）。
Sabes 参与者每月接受 HIV 检测，以确定急性或早期感染，HIV 阳性参与者被随机分配到立即（即刻治疗组）或在 48 周随访期间 24 周后（延迟治疗组）接受抗逆转录病毒治疗。在随机分组时（基线）和之后每 12 周评估性行为。参与者在基线、12、24 和 48 周时接受尿道和直肠衣原体和淋病以及梅毒检测。我们描述了 48 周随访期间的性行为模式，并比较了研究臂之间的性行为和 STI 发生率。
随机分组后，207 名 HIV 阳性参与者完成了 2 次或更多次就诊的问卷和 STI 检测。HIV 诊断后，两个治疗组的参与者均报告与主要和偶然伴侣发生性行为时使用安全套的比例增加，在肛交前后使用药物和酒精的比例降低。我们未观察到治疗臂之间的性行为差异。延迟治疗组的衣原体感染发生率较高（发病率比，2.33；95%置信区间，1.14-4.77），但淋病和梅毒的发生率没有差异。
尽管报告的安全套使用有所增加，但 STI 的总体高发率反映了 HIV 阳性男男性行为者和跨性别女性中仍存在一些无保护性行为，这突显了定期进行 STI 筛查和咨询的重要性，以支持 HIV 阳性个体中 STI 高危人群持续使用安全套。
