Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA.
Department of Epidemiology, Fielding School of Public Health, 25808University of California Los Angeles, CA, USA.
Int J STD AIDS. 2022 Mar;33(4):397-403. doi: 10.1177/09564624211053428. Epub 2022 Mar 3.
HIV PrEP effectiveness is highly dependent on adherence. High STI incidence has been reported among PrEP users. We assessed the relationship between STI incidence (CT, NG, and syphilis) and PrEP adherence.
We performed a subanalysis of a controlled, open-label, two-arm, randomized clinical demonstration project of a text-message based adherence intervention. Participants had 48 weeks of follow-up and had STI testing every 12 or 24 weeks. PrEP adherence was measured at week 48 using intracellular tenofovir-diphosphate drug concentrations. We calculated incidence rate ratios for STIs among those adherent as compared with those not adherent to PrEP.
Of the 381 assessed for CT, NG and syphilis at one or more follow-up visits, there were 16 cases of syphilis or 5.0 per 100 person years (95% CI: 2.6, 7.5); 63 cases of NG or 26.3 per 100 person years (95% CI: 19.8, 32.8); and 81 cases of CT or 36.3 per 100 person years (95% CI: 28.4, 44.2). We found no association between adequate PrEP adherence and STI incidence (aIRR: 0.97 95% CI: 0.67, 1.40).
We found that the incidence of STIs was not significantly different between those adherent to PrEP and those non-adherent. Further research is needed to assess how PrEP use may impact STIs over time.
HIV 暴露前预防（PrEP）的有效性高度依赖于用药依从性。有研究报道 PrEP 使用者的性传播感染（STI）发病率较高。我们评估了 STI 发病率（CT、NG 和梅毒）与 PrEP 依从性之间的关系。
我们对一项基于短信的依从性干预的对照、开放标签、两臂、随机临床示范项目进行了亚分析。参与者随访 48 周，每 12 或 24 周进行一次 STI 检测。在第 48 周时使用细胞内替诺福韦二磷酸药物浓度来测量 PrEP 依从性。我们计算了依从性 PrEP 与不依从性 PrEP 的 STI 发生率比（IRR）。
在 381 名接受了一次或多次随访的 CT、NG 和梅毒检测的参与者中，有 16 例梅毒，发病率为每 100 人年 5.0 例（95%CI：2.6，7.5）；63 例 NG，发病率为每 100 人年 26.3 例（95%CI：19.8，32.8）；81 例 CT，发病率为每 100 人年 36.3 例（95%CI：28.4，44.2）。我们没有发现充分的 PrEP 依从性与 STI 发病率之间存在关联（调整 IRR：0.97，95%CI：0.67，1.40）。
我们发现，依从性 PrEP 与不依从性 PrEP 的 STI 发病率没有显著差异。需要进一步研究来评估 PrEP 使用随时间推移如何影响 STI。
