Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt am Main, Germany.
HIV Med. 2023 Feb;24(2):163-169. doi: 10.1111/hiv.13353. Epub 2022 Jul 20.
After pre-exposure prophylaxis (PrEP) was introduced, rates of sexually transmitted infections (STIs) increased among PrEP users. However, data on STI trends in people living with HIV since then are limited. Since September 2019, PrEP has been covered by statutory German health insurance (SHI) in vulnerable groups. This study aimed to determine whether this coverage of PrEP costs affected STI rates in people living with HIV (specifically, men who have sex with men).
All patients of the HIVCENTER Frankfurt diagnosed with at least one STI within the observation period were retrospectively enrolled in the study. STIs included infection with Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. The observation period covered 1 year before and 1 year after the coverage of PrEP costs by German SHI. Data were collected from outpatient clinic records.
In total, 143 patients were enrolled in the study. The observation period was September 2018 to August 2019 for group 1 (n = 73) and September 2019 to August 2020 for group 2 (n = 70). The most frequent STIs were syphilis and infections due to chlamydia, gonococci, and trichomonads, in descending order. Infections with T. pallidum occurred more often in group 2 than in group 1 (60.0% vs. 50.7%; p = 0.253) as did chlamydia (37.1% vs. 28.8%; p = 0.286).
A tendency for an increased ratio of STIs in people living with HIV was observed after the introduction of PrEP coverage by German SHI. STIs should be discussed intensively with people living with HIV, since the communities of PrEP users and people living with HIV overlap, and changes in risk behaviour might influence both groups.
暴露前预防（PrEP）推出后，PrEP 使用者的性传播感染（STI）率有所上升。然而，此后关于 HIV 感染者的 STI 趋势的数据有限。自 2019 年 9 月以来，PrEP 已被德国法定健康保险（SHI）覆盖弱势群体。本研究旨在确定 PrEP 费用的覆盖是否影响了 HIV 感染者（特别是男男性行为者）的 STI 率。
在观察期内，所有在法兰克福 HIV 中心诊断出至少一种 STI 的患者均被纳入研究。STIs 包括梅毒螺旋体、沙眼衣原体、淋病奈瑟菌和/或阴道毛滴虫感染。观察期包括德国 SHI 覆盖 PrEP 费用之前的 1 年和之后的 1 年。数据来自门诊记录。
共有 143 名患者纳入研究。第 1 组的观察期为 2018 年 9 月至 2019 年 8 月（n=73），第 2 组为 2019 年 9 月至 2020 年 8 月（n=70）。最常见的 STIs 依次为梅毒、衣原体、淋病和滴虫感染。第 2 组的梅毒感染率高于第 1 组（60.0% vs. 50.7%；p=0.253），衣原体感染率也高于第 1 组（37.1% vs. 28.8%；p=0.286）。
在德国 SHI 引入 PrEP 覆盖后，HIV 感染者的 STI 比例呈上升趋势。由于 PrEP 用户和 HIV 感染者的群体重叠，因此应该与 HIV 感染者深入讨论 STIs，因为行为风险的变化可能会影响这两个群体。
