Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Nguyen K Tran, Seth L Welles, Jason A Roy, David J Brennan, Esther Chernak, Neal D Goldstein
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引用次数: 0

Abstract

Purpose: HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence.

Methods: We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification.

Results: Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06).

Conclusions: We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population.Annals Early Access article.

安大略省男同性恋、双性恋或男男性行为者自述的 PrEP 使用情况和细菌性性传播疾病风险。
目的:HIV 暴露前预防(PrEP)可能会通过风险补偿(如无套性行为或性伴侣数量的增加)增加男同性恋、双性恋和其他男男性行为者(GBM)的细菌性传播感染(STI)率;然而,探索 PrEP 摄入量和细菌性传播感染的时间依赖性的纵向研究非常有限。我们使用边际结构模型来估算 PrEP 摄入对 STI 发病率的影响:我们分析了 2017 年 7 月至 2018 年 4 月期间对 535 名安大略省 GBM 进行的在线纵向研究 iCruise 研究的数据,以估计 PrEP 摄入量对通过 12 篇每周日记收集的自我报告的细菌性 STI(衣原体、淋病和梅毒)发病率的影响。发病率按每 100 人月的感染人数计算,并对性传播感染的整体和个体进行评估。我们使用边际结构模型来考虑时变混杂因素,并使用定量偏差分析来评估估计值对非差异结果误分类的敏感性:我们对参与的 GBM 共进行了 1,623.5 人月的随访。总体而言,70 名参与者(13.1%)在研究期间服用了 PrEP。相对于未采取PrEP措施,采取PrEP措施与淋病发病率增加有关(发病率比=4.00;95% CI,1.67-9.58),但与衣原体或梅毒的发病率无关,与任何细菌性性传播感染的总体发病率无关。考虑到错误分类,淋病的中位发病率比为 2.36(95% 模拟区间为 1.08-5.06):我们观察到,在安大略省的 GBM 中,淋病发病率的增加与 PrEP 的摄取有关,而这种增加与误分类无关。尽管我们的研究结果支持将淋病筛查与 PrEP 服务相结合的现行指南,但更多的研究应考虑 PrEP 在这一人群中的长期影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Family Medicine
Annals of Family Medicine 医学-医学:内科
CiteScore
3.70
自引率
4.50%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Annals of Family Medicine is a peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve.
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