Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection

被引：300

作者：

Traeger, Michael W. ^{[2
]}

Cornelisse, Vincent J. ^{[3
,4
,5
,6
,7
,31
]}

Asselin, Jason ^{[2
]}

Price, Brian ^{[3
,4
]}

Roth, Norman J. ^{[6
,31
]}

Willcox, Jeff ^{[8
]}

Tee, Ban Kiem ^{[9
]}

Fairley, Christopher K. ^{[5
,7
]}

Chang, Christina C. ^{[3
,4
,7
]}

Armishaw, Jude ^{[3
,4
]}

Vujovic, Olga ^{[3
,4
]}

Penn, Matthew ^{[10
]}

Cundill, Pauline ^{[10
]}

Forgan-Smith, George ^{[11
]}

Gall, John ^{[11
]}

Pickett, Claire ^{[12
]}

Mak, Anne ^{[3
,4
]}

Spelman, Tim D. ^{[2
,13
,14
]}

Long Nguyen ^{[2
]}

Murphy, Dean A. ^{[15
,16
]}

Ryan, Kathleen E. ^{[2
,3
,4
]}

El-Hayek, Carol ^{[2
]}

West, Michael ^{[17
]}

Ruth, Simon ^{[18
]}

Batrouney, Colin ^{[18
]}

Lockwood, John T. ^{[3
,4
]}

Hoy, Jennifer F. ^{[3
,4
]}

Hellard, Margaret E. ^{[2
,3
,4
,13
]}

Stoove, Mark A. ^{[2
,13
]}

Wright, Edwina J. ^{[2
,3
,4
,14
]}

de Wit, John ^{[19
]}

Lal, Luxi ^{[2
]}

Audsley, Jennifer ^{[3
,4
,14
,20
]}

Duncan, Alison ^{[21
]}

Sasadeusz, Joe ^{[20
,21
,22
]}

Allan, Brent ^{[23
]}

Whelan, Michael ^{[24
]}

McPhail, Daniel ^{[25
]}

Wilson, David ^{[1
]}

Holt, Martin ^{[16
]}

Williams, Chris ^{[25
]}

Wesselingh, Steve ^{[26
]}

Ward, James ^{[26
]}

Gallant, Danny ^{[26
]}

Ward, Alison ^{[27
,28
]}

Chong, Alistair ^{[21
,29
]}

McKinnon, Katharine ^{[30
]}

Aguirre, Ivette ^{[21
]}

Read, Timothy ^{[5
]}

Moore, Richard ^{[8
]}

机构：

[1] Burnet Inst, 85 Commercial Rd, Melbourne, Vic 3004, Australia

[2] Burnet Inst, Dis Eliminat Program, Melbourne, Vic, Australia

[3] Alfred Hlth, Dept Infect Dis, Melbourne, Vic, Australia

[4] Monash Univ, Melbourne, Vic, Australia

[5] Alfred Hlth, Melbourne Sexual Hlth Ctr, Melbourne, Vic, Australia

[6] Prahran Market Clin, Melbourne, Vic, Australia

[7] Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia

[8] Northside Clin, Melbourne, Vic, Australia

[9] Thorne Harbour Hlth, Ctr Clin, Melbourne, Vic, Australia

[10] Thorne Harbour Hlth, PRONTO Clin, Melbourne, Vic, Australia

[11] ERA Hlth, Melbourne, Vic, Australia

[12] Ballarat Community Hlth Ctr, Ballarat, Vic, Australia

[13] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia

[14] Univ Melbourne, Peter Doherty Inst Infect & Immun, Melbourne, Vic, Australia

[15] Univ Sydney, Dept Gender & Cultural Studies, Sydney, NSW, Australia

[16] Univ New South Wales, Kirby Inst, Sydney, NSW, Australia

[17] Govt Victoria, Dept Hlth & Human Serv, Sexual Hlth & Viral Hepatitis Serv, Melbourne, Vic, Australia

[18] Thorne Harbour Hlth, Melbourne, Vic, Australia

[19] Univ New South West, Ctr Social Res Hlth, Sydney, NSW, Australia

[20] Royal Melbourne Hosp, Melbourne, Vic, Australia

[21] The Alfred, Alfred Hlth, Melbourne, Vic, Australia

[22] Peter Doherty Inst Infect & Immun, Melbourne, Vic, Australia

[23] Living Posit Victoria, Melbourne, Vic, Australia

[24] PAN PrEP Access Now, Melbourne, Vic, Australia

[25] PrEPd Change, Melbourne, Vic, Australia

[26] South Australian Hlth & Med Res Inst, Adelaide, SA, Australia

[27] Adelaide Sexual Hlth Ctr, Adelaide, SA, Australia

[28] Royal Adelaide Hosp, Adelaide, SA, Australia

[29] Univ Melbourne, Melbourne, Vic, Australia

[30] La Trobe Univ, Melbourne, Vic, Australia

[31] Prahran Market Clin, Melbourne, Vic, Australia

[32] Geelong Hosp, Geelong, Vic, Australia

[33] Barwon Hlth, Geelong, Vic, Australia

[34] OBrien St Practice, Adelaide, SA, Australia

[35] Riverside Family Med Practice, St Marys, SA, Australia

[36] SHINE SA, Woodville, SA, Australia

[37] Sexual Hlth Serv Tasmania, Hobart, Tas, Australia

[38] Clin 60, Hobart, Tas, Australia

[39] Clin 34, Launceston, Tas, Australia

[40] Harm Reduct Victoria, North Melbourn, Vic, Australia

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2019年 / 321卷 / 14期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

MEN; SEX; CHLAMYDIA;

D O I：

10.1001/jama.2019.2947

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Emerging evidence suggests that risk of bacterial sexually transmitted infections (STIs) increases among gay and bisexual men following initiation of HIV preexposure prophylaxis (PrEP). OBJECTIVE To describe STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to explore changes in STI incidence following PrEP commencement. DESIGN, SETTING, AND PARTICIPANTS The Pre-exposure Prophylaxis Expanded (PrEPX) Study, a multisite, open-label intervention study, was nested within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. A total of 4275 participants were enrolled (July 26, 2016-April 1, 2018) in Victoria, Australia. Of these, 2981 enrolled at 5 ACCESS clinics (3 primary care, 1 sexual health, and 1 community-based HIV rapid testing service), had at least 1 follow-up visit, and were monitored until April 30, 2018. EXPOSURES Upon enrollment, participants received daily oral tenofovir disoproxil fumurate and emtricitabine for HIV PrEP, quarterly HIV and STI testing, and clinical monitoring. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of chlamydia, gonorrhea, or syphilis. Incidence rates and hazard ratios describing behavioral risk factors of STI diagnosis were calculated. Incidence rate ratios (IRRs), adjusted for change in testing frequency, described changes in STI incidence from 1-year preenrollment to study follow-up among participants with preenrollment testing data (n = 1378). RESULTS Among the 2981 individuals (median age, 34 years [interquartile range, 28-42]), 98.5% identified as gay or bisexual males, 29% used PrEP prior to enrollment, 89 (3%) withdrew and were censored at date of withdrawal, leaving 2892 (97.0%) enrolled at final follow-up. During a mean follow-up of 1.1 years (3185.0 person-years), 2928 STIs were diagnosed among 1427 (48%) participants (1434 chlamydia, 1242 gonorrhea, 252 syphilis). STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STIs. Among 2058 participants with complete data for multivariable analysis, younger age, greater partner number, and group sex were associated with greater STI risk, but condom use was not. Among 1378 participants with preenrollment testing data, STI incidence increased from 69.5 per 100 person-years prior to enrollment to 98.4 per 100 person-years during follow-up (IRR, 1.41 [95% CI, 1.29-1.56]). After adjusting for testing frequency, the increase in incidence from 1 year preenrollment to follow-up was significant for any STI (adjusted IRR, 1.12 [95% CI, 1.02-1.23]) and for chlamydia (adjusted IRR, 1.17 [95% CI, 1.04-1.33]). CONCLUSIONS AND RELEVANCE Among gay and bisexual men using PrEP, STIs were highly concentrated among a subset, and receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with preenrollment. These findings highlight the importance of frequent STI testing among gay and bisexual men using PrEP.

引用

页码：1380 / 1390

页数：11

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