Unigwe Ikenna F, Goodin Amie, Lo-Ciganic Wei-Hsuan, Cook Robert L, Janelle Jennifer, Park Haesuk
Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Open Forum Infect Dis. 2024 Oct 2;11(10):ofae569. doi: 10.1093/ofid/ofae569. eCollection 2024 Oct.
Pre-exposure prophylaxis (PrEP) effectiveness is highly dependent on medication adherence, which is associated with differential HIV risks and possibly sexually transmitted infection (STI).
This retrospective cohort study of PrEP users (01/01/2012-12/31/2021) used the MarketScan database of commercially insured enrollees to examine PrEP adherence trajectory groups' associations with HIV and STI acquisition risks. Distinct PrEP adherence trajectories were identified by group-based trajectory modeling among individuals who used oral PrEP. The primary outcome was HIV acquisition incidence, and secondary was STI rate, compared among trajectory groups. Inverse probability treatment weighting time-varying Cox proportional hazards models assessed HIV acquisition, and Poisson regression models assessed STI.
Among 23 258 oral PrEP users, 4 distinct PrEP adherence patterns were identified: minimal use (10.5% of the cohort), rapidly declining (25.4%), gradually declining (24.3%), and consistently high (39.8%). Compared with the minimal use group, the gradually declining (adjusted hazard ratio [AHR], 0.53; 95% CI, 0.31-0.90) and consistently high (AHR, 0.50; 95% CI, 0.30-0.84) PrEP adherence groups showed decreased HIV incidence risks. Compared with the minimal use group, the rapidly declining (adjusted incidence rate ratio [AIRR], 1.35; 95% CI, 1.07-1.72), gradually declining (AIRR, 1.73; 95% CI, 1.38-2.18), and consistently high (AIRR, 2.06; 95% CI, 1.64-2.58) groups were associated with increased STI risk.
These findings underscore the benefits of continuing and remaining adherent to PrEP and may also inform public health strategies, clinical guidelines, and interventions aimed at maximizing the effectiveness of PrEP in reducing new HIV infections while developing targeted strategies to prevent STIs with PrEP use.
暴露前预防（PrEP）的有效性高度依赖于药物依从性，而这与不同的HIV风险以及可能的性传播感染（STI）相关。
这项对PrEP使用者（2012年1月1日至2021年12月31日）的回顾性队列研究使用了商业保险参保者的MarketScan数据库，以检查PrEP依从轨迹组与HIV和STI感染风险之间的关联。通过基于群组的轨迹建模在使用口服PrEP的个体中确定不同的PrEP依从轨迹。主要结局是HIV感染发生率，次要结局是STI发生率，在各轨迹组之间进行比较。逆概率处理加权时变Cox比例风险模型评估HIV感染情况，泊松回归模型评估STI情况。
在23258名口服PrEP使用者中，确定了4种不同的PrEP依从模式：极少使用（占队列的10.5%）、快速下降（25.4%）、逐渐下降（24.3%）和持续高依从（39.8%）。与极少使用组相比，逐渐下降组（调整后风险比[AHR]，0.53；95%置信区间[CI]，0.31 - 0.90）和持续高依从组（AHR，0.50；95% CI，0.30 - 0.84）的HIV感染风险降低。与极少使用组相比，快速下降组（调整后发病率比[AIRR]，1.35；95% CI，1.07 - 1.72）、逐渐下降组（AIRR，1.73；95% CI，1.38 - 2.18）和持续高依从组（AIRR，2.06；95% CI，1.64 - 2.58）与STI风险增加相关。
这些发现强调了持续坚持PrEP的益处，也可能为公共卫生策略、临床指南以及旨在最大化PrEP在减少新HIV感染方面有效性的干预措施提供信息，同时制定针对性策略以预防因使用PrEP而导致的STIs。
