Infectious Diseases Unit, San Raffaele Hospital, Milano, Italy
Infectious Diseases Unit, Vita-Salute San Raffaele University, Milano, Italy.
BMJ Open. 2022 Dec 20;12(12):e067261. doi: 10.1136/bmjopen-2022-067261.
Pre-exposure prophylaxis (PrEP) is effective for HIV prevention and is mostly used by men who have sex with men (MSM). The aim of this study was to describe the characteristics of a cohort of PrEP users at first PrEP counselling visits (baseline, BL).
Cross-sectional study of a cohort of MSM receiving PrEP (Centro San Luigi, CSL-PrEP Cohort).
Secondary-level sexually transmitted infections (STI) centre in Milan, Italy, from May 2017 to May 2022.
Overall, 624 MSM PrEP users were included; most users were Caucasian (97%), attended university (64%), with a median BL age of 34.5 years.
Overall, 45% choose the daily-based PrEP regimen, 55% the event-based one. An increasing trend in PrEP counselling visits was observed (p=0.024). The majority had between 10 and 19 partners in the 3 months before BL and 41% were chemsex users. All had a HIV Incidence Risk Index for MSM (HIRI-MSM)>10, 54% between 20 and 29. Overall, 50% had ≥1 previous STI and 22% ≥1 BL STI. BL chlamydia (10%) was often more frequent than in the past (7%). The number of sexual partners was associated with BL chlamydia (p<0.001), gonorrhoea (p=0.002) and syphilis (p=<0.001), HIRI-MSM with chlamydia (p=0.001) and gonorrhoea (p=0.008), chemsex use with chlamydia (p=0.003) and gonorrhoea (p=0.030).
We observed an unbalanced access to PrEP in respect to all key populations which might benefit from PrEP, with a similar choice for event-based or daily-based regimens. High-risk behaviours and STIs were frequently observed. History of chlamydia was very frequently high in asymptomatic MSM at BL, compared with what observed before access to PrEP. High-risk behaviours and HIRI-MSM were associated with most of STIs.
暴露前预防（PrEP）对 HIV 预防有效，主要用于男男性行为者（MSM）。本研究旨在描述首次接受 PrEP 咨询时（基线，BL）PrEP 使用者队列的特征。
米兰二级性传播感染（STI）中心的 MSM 接受 PrEP 的队列研究（Centro San Luigi，CSL-PrEP 队列）。
意大利米兰，2017 年 5 月至 2022 年 5 月。
共纳入 624 名 MSM PrEP 使用者；大多数使用者为白人（97%），上过大学（64%），BL 时的中位年龄为 34.5 岁。
总体而言，45%的人选择了每日方案，55%的人选择了按需方案。PrEP 咨询访问量呈上升趋势（p=0.024）。大多数人在 BL 前 3 个月有 10-19 个性伴侣，41%的人使用化学性行为。所有人的男男性行为者 HIV 感染风险指数（HIRI-MSM）均>10，54%在 20-29 之间。总体而言，50%的人有≥1 次既往性传播感染，22%的人在 BL 时有≥1 次性传播感染。BL 时的衣原体（10%）感染频率高于既往（7%）。性伴侣数量与 BL 时的衣原体（p<0.001）、淋病（p=0.002）和梅毒（p<0.001）、HIRI-MSM 与衣原体（p=0.001）和淋病（p=0.008）、化学性行为与衣原体（p=0.003）和淋病（p=0.030）有关。
我们观察到 PrEP 在所有可能受益于 PrEP 的关键人群中存在不平衡的获得情况，且对按需或每日方案的选择相似。高危行为和性传播感染频繁发生。无症状 MSM 在 BL 时的衣原体既往史非常高，高于 PrEP 前的观察结果。高危行为和 HIRI-MSM 与大多数性传播感染有关。
