van den Elshout Mark A M, Wijstma Eline S, Boyd Anders, Jongen Vita, Coyer Liza, Anderson Peter L, Davidovich Udi, de Vries Henry J C, Prins Maria, Schim van der Loeff Maarten F, Hoornenborg Elske
GGD Amsterdam, afd. Infectieziekten, Amsterdam.
Contact:
Ned Tijdschr Geneeskd. 2024 Oct 21;168:D8334.
HIV can be effectively prevented by oral HIV pre-exposure prophylaxis (PrEP). When PrEP was introduced, there was apprehension that condom use would decrease and STIs would increase. The purpose of this study was to investigate sexual behaviour and STI incidence among PrEP users.
Prospective cohort study METHODS: The Amsterdam PrEP demonstration project (AMPrEP) provided oral PrEP to men who have sex with men (MSM) and transgender women from 2015 to 2020. Participants could choose between daily and event-driven PrEP. We tested for HIV and STIs at each quarterly study visit. We examined changes in numbers of sex partners and frequency of condomless anal sex with casual partners (CAS) with negative binomial regression. We examined HIV incidence, and changes in STI incidence using Poisson regression.
367 participants (365 MSM) initiated PrEP, median duration of participation was 3.9 years (interquartile range[IQR]=3.4-4.0). Median number of sex partners per three months was 13 (IQR=6-26) and decreased with each additional year on PrEP (adjusted rate ratio[aRR]=0.86/year, 95%confidence interval[CI]=0.83-0.88). Frequency of CAS per three months was 10 (IQR=3-20.5) and also decreased (aRR=0.92/year, 95%CI=0.88-0.97). Incidence of any STI was 87/100PY (95%CI=82-92) and did not increase over time. Two HIV infections were diagnosed (incidence=0.2/100PY; 95%CI=0.0-0.6), both during the first year and among daily PrEP users.
In this prospective cohort with an observation period of four years, we observed a low HIV incidence and a decrease in the number of sex partners and CAS over time. Although STI incidence was high, it did not increase.
口服艾滋病病毒暴露前预防（PrEP）可有效预防艾滋病病毒（HIV）。PrEP引入时，人们担心避孕套的使用会减少，性传播感染（STIs）会增加。本研究的目的是调查PrEP使用者的性行为和STIs发病率。
前瞻性队列研究
阿姆斯特丹PrEP示范项目（AMPrEP）在2015年至2020年期间为男男性行为者（MSM）和跨性别女性提供口服PrEP。参与者可以在每日服用和事件驱动型PrEP之间进行选择。我们在每次季度研究访视时检测HIV和STIs。我们使用负二项回归分析性伴侣数量的变化以及与偶然伴侣（CAS）无保护肛交频率的变化。我们使用泊松回归分析HIV发病率以及STIs发病率的变化。
367名参与者（365名MSM）开始使用PrEP，参与的中位持续时间为3.9年（四分位间距[IQR]=3.4 - 4.0）。每三个月的性伴侣中位数为13名（IQR=6 - 26），且随着使用PrEP年限的增加而减少（调整率比[aRR]=0.86/年，95%置信区间[CI]=0.83 - 0.88）。每三个月的CAS频率为10次（IQR=3 - 20.5），也有所下降（aRR=0.92/年，95%CI=0.88 - 0.97）。任何STI的发病率为87/100人年（95%CI=82 - 92），且未随时间增加。诊断出两例HIV感染（发病率=0.2/100人年；95%CI=0.0 - 0.6），均发生在第一年且为每日服用PrEP的使用者中。
在这个为期四年的前瞻性队列研究中，我们观察到HIV发病率较低，且随着时间推移性伴侣数量和CAS数量减少。虽然STIs发病率较高，但并未增加。
