Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis

September 2, 2018 at 10:36 am

Clinical Infectious Diseases September 1, 2018 V.67 N.5 P.676–686

EDITOR’S CHOICE

Michael W Traeger; Sophia E Schroeder; Edwina J Wright; Margaret E Hellard; Vincent J Cornelisse..

This systematic review and meta-analysis of 17 open-label studies published to 2017 found that daily HIV pre-exposure prophylaxis use among men who have sex with men is associated with increased sexually transmitted infection diagnoses and an increase in condomless sex.

Background

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM.

Methods

We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed.

Results

Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19–2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99–1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.

Conclusion

Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.

FULL TEXT

https://academic.oup.com/cid/article/67/5/676/4917600

PDF (CLIC en PDF)

Entry filed under: Antirretrovirales, Biología Molecular, Epidemiología, HIV/SIDA, HIV/SIDA HAART, HIV/SIDA HSH, HIV/SIDA Prevencion, Infecciones virales, Meta-Análisis, Metodos diagnosticos, REPORTS, REVIEWS, Update.

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