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SDG 3: HIV/AIDS

Abstract

Background

Pre-exposure prophylaxis (PrEP) effectively prevents HIV, but its association with sexually transmitted infections (STIs) has raised concerns about risk compensation, potentially impacting the expansion of PrEP programmes.

Aim

We examined the relationship between PrEP and the incidence of chlamydia, gonorrhoea and syphilis.

Methods

In this prospective cohort study, we compared STI rates before and after PrEP initiation among users in the capital region of Denmark (2019–2022), calculating incidence rate ratios adjusted for age and testing frequency (aIRR). To pinpoint when increases began, we plotted weekly STI rates, adjusting the timeline to correspond with PrEP initiation.

Results

The study included 1,326 PrEP users with a median age of 35 years. The STI incidence rate per 100,000 person-years rose from 35.3 before to 81.2 after PrEP start, with an aIRR of 1.35 (95% CI: 1.18–1.56). Notably, this increase preceded PrEP initiation by 10–20 weeks. Specific aIRR for chlamydia, gonorrhoea and syphilis were 1.23 (95% CI: 1.03–1.48), 1.24 (95% CI: 1.04–1.47) and 1.15 (95% CI: 0.76–1.72), respectively. In subanalyses for anatomical sites aIRR was 1.26 (95% CI: 1.01–1.56) for rectal chlamydia and 0.66 (95% CI: 0.45–0.96) for genital gonorrhoea.

Conclusion

We found a 35% increase in STI incidence associated with PrEP use. It started before PrEP initiation, challenging the assumption that PrEP leads to risk compensation. Instead, the data suggest that individuals seek PrEP during periods of heightened sexual risk-taking. Consequently, PrEP programmes should include sexual health consultations, STI testing, treatment and prevention strategies to prevent HIV and improve sexual health.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2024-03-28
2024-12-12
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.13.2300451
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References

  1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60.  https://doi.org/10.1016/S0140-6736(15)00056-2  PMID: 26364263 
  2. Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125.  https://doi.org/10.1126/scitranslmed.3004006  PMID: 22972843 
  3. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Web supplement. Annex 2: Evidence to decision-making tables and supporting evidence WHO/HIV/2015.36. Geneva: WHO; 2015. Available from: http://apps.who.int/iris/bitstream/10665/189977/1/WHO_HIV_2015.36_eng.pdf?ua=1
  4. AIDS Vaccine Advocacy Coalition (AVAC). The global PrEP tracker. New York: AVAC. [Accessed: 23 Dec 2023.. Available from: https://data.prepwatch.org
  5. Ramchandani MS, Golden MR. Confronting rising STIs in the era of PrEP and treatment as prevention. Curr HIV/AIDS Rep. 2019;16(3):244-56.  https://doi.org/10.1007/s11904-019-00446-5  PMID: 31183609 
  6. Traeger M, Stoové M. Why risk matters for STI control: who are those at greatest risk and how are they identified? Sex Health. 2022;19(4):265-77.  https://doi.org/10.1071/SH22053  PMID: 35705518 
  7. Quaife M, MacGregor L, Ong JJ, Gafos M, Torres-Rueda S, Grant H, et al. Risk compensation and STI incidence in PrEP programmes. Lancet HIV. 2020;7(4):e222-3.  https://doi.org/10.1016/S2352-3018(19)30333-9  PMID: 31767536 
  8. Milam J, Jain S, Dubé MP, Daar ES, Sun X, Corado K, et al. Sexual risk compensation in a pre-exposure prophylaxis demonstration study among individuals at risk for HIV. J Acquir Immune Defic Syndr. 2019;80(1):e9-13.  https://doi.org/10.1097/QAI.0000000000001885  PMID: 30334877 
  9. Blumenthal J, Haubrich R. Will risk compensation accompany pre-exposure prophylaxis for HIV? Virtual Mentor. 2014;16(11):909-15. PMID: 25397651 
  10. Hedlund J. Risky business: safety regulations, risks compensation, and individual behavior. Inj Prev. 2000;6(2):82-90.  https://doi.org/10.1136/ip.6.2.82  PMID: 10875661 
  11. Holt M, Murphy DA. Individual versus community-level risk compensation following preexposure prophylaxis of HIV. Am J Public Health. 2017;107(10):1568-71.  https://doi.org/10.2105/AJPH.2017.303930  PMID: 28817332 
  12. Rojas Castro D, Delabre RM, Molina J-M. Give PrEP a chance: moving on from the "risk compensation" concept. J Int AIDS Soc. 2019;22(Suppl) Suppl 6;e25351.  https://doi.org/10.1002/jia2.25351  PMID: 31468693 
  13. Konnoth CJ. Drugs’ other side-effects. Iowa Law Rev. 2019;105:171. Available from: https://ilr.law.uiowa.edu/print/volume-105-issue-1/drugs-other-side-effects
  14. Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, et al. 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. Clin Infect Dis. 2018;67(5):676-86.  https://doi.org/10.1093/cid/ciy182  PMID: 29509889 
  15. Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA. 2019;321(14):1380-90.  https://doi.org/10.1001/jama.2019.2947  PMID: 30964528 
  16. Ayerdi Aguirrebengoa O, Vera García M, Arias Ramírez D, Gil García N, Puerta López T, Clavo Escribano P, et al. Low use of condom and high STI incidence among men who have sex with men in PrEP programs. PLoS One. 2021;16(2):e0245925.  https://doi.org/10.1371/journal.pone.0245925  PMID: 33539363 
  17. Hoornenborg E, Coyer L, van Laarhoven A, Achterbergh R, de Vries H, Prins M, et al. Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use: results from the Amsterdam pre-exposure prophylaxis demonstration project. AIDS. 2018;32(11):1527-32.  https://doi.org/10.1097/QAD.0000000000001874  PMID: 29762169 
  18. Hoornenborg E, Coyer L, Achterbergh RCA, Matser A, Schim van der Loeff MF, Boyd A, et al. Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study. Lancet HIV. 2019;6(7):e447-55.  https://doi.org/10.1016/S2352-3018(19)30136-5  PMID: 31178284 
  19. Frisch M, Moseholm E, Andersson M, Andresen JB, Graugaard C. Sex i Danmark-Nøgletal fra projekt SEXUS 2017-2018. [Sex in Denmark. Key findings from project SEXUS 2017-2018]. Copenhagen: Statens Serum Institut; 2019. Danish. Available: https://vbn.aau.dk/en/publications/sex-i-denmark-n%C3%B8gletal-fra-projekt-sexus-2017-2018
  20. Page-Shafer K, Shiboski CH, Osmond DH, Dilley J, McFarland W, Shiboski SC, et al. Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS. 2002;16(17):2350-2.  https://doi.org/10.1097/00002030-200211220-00022  PMID: 12441814 
  21. Nguyen V-K, Greenwald ZR, Trottier H, Cadieux M, Goyette A, Beauchemin M, et al. Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV. AIDS. 2018;32(4):523-30.  https://doi.org/10.1097/QAD.0000000000001718  PMID: 29239887 
  22. AIDS-fondet. Checkpoint. Copenhagen: AIDS-fondet. [Accessed: 23 Dec 2023]. Available from: https://aidsfondet.dk/checkpoint/om-checkpoint
  23. Danish Dermatological Society (DDS). DDS-vejledning vedrørende Seksuelt Overførbare Infektioner. [DDS guidance regarding sexually transmitted infections]. DDS; 2021. Danish. Available from: https://dds.nu/wp-content/uploads/2021/12/DDS-vejledning-SOI_version-1.1_22.12.2021.pdf
  24. Statens Serum Institut (SSI). Standard Test Syfilis (fuld us.) (inklusiv intrathekalsyntese) (R-nr. 322). [Standard syphilis test (full investigation) (including intrathecal synthesis) (no. 322)]. Copenhagen: SSI. [Accessed: 11 Dec 2023]. Danish. Available from: https://www.ssi.dk/produkter-og-ydelser/diagnostik/diagnostiskhaandbog/s/322
  25. Frank, EF. Opdateret retningslinje for opdatering af PrEP. [Updated guideline for updating PrEP]. Copenhagen: Danske Regioner; 2021. Danish. Available from: https://www.regioner.dk/media/14858/opdateret-retningslinje-for-udlevering-af-prep_11221.pdf
  26. Azarnoosh M, Johansen IS, Martin-Iguacel R. Incidence of sexually transmitted infections after initiating HIV pre-exposure prophylaxis among MSM in southern Denmark. Am J Mens Health. 2021;15(3):15579883211018917.  https://doi.org/10.1177/15579883211018917  PMID: 34036826 
  27. Nguyen VK, Greenwald ZR, Trottier H, Cadieux M, Goyette A, Beauchemin M, et al. Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV. AIDS. 2018;32(4):523-30.  https://doi.org/10.1097/QAD.0000000000001718  PMID: 29239887 
  28. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60.  https://doi.org/10.1016/S0140-6736(15)00056-2  PMID: 26364263 
  29. McManus H, Grulich AE, Amin J, Selvey C, Vickers T, Bavinton B, et al. Comparison of trends in rates of sexually transmitted infections before vs after initiation of HIV preexposure prophylaxis among men who have sex with men. JAMA Netw Open. 2020;3(12):e2030806.  https://doi.org/10.1001/jamanetworkopen.2020.30806  PMID: 33355675 
  30. Earnest R, Rönn MM, Bellerose M, Gift TL, Berruti AA, Hsu KK, et al. Population-level benefits of extragenital gonorrhea screening among men who have sex with men: an exploratory modeling analysis. Sex Transm Dis. 2020;47(7):484-90.  https://doi.org/10.1097/OLQ.0000000000001189  PMID: 32355108 
Questioning risk compensation: pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sebastian+von+Schreeb&option1=author&noRedirect=true" class="nonDisambigAuthorLink">von Schreeb Sebastian</a>, <a href="/search?value1=Susanne+Kriegel+Pedersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pedersen Susanne Kriegel</a>, <a href="/search?value1=Hanne+Christensen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Christensen Hanne</a>, <a href="/search?value1=Kristina+Melbardis+J%C3%B8rgsensen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jørgsensen Kristina Melbardis</a>, <a href="/search?value1=Lene+Holm+Harritsh%C3%B8j&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harritshøj Lene Holm</a>, <a href="/search?value1=Frederik+Boetius+Hertz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hertz Frederik Boetius</a>, <a href="/search?value1=Magnus+Glindvad+Ahlstr%C3%B6m&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ahlström Magnus Glindvad</a>, <a href="/search?value1=Anne-Mette+Lebech&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lebech Anne-Mette</a>, <a href="/search?value1=Suzanne+Lunding&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lunding Suzanne</a>, <a href="/search?value1=Lars+N%C3%B8rregaard+Nielsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nielsen Lars Nørregaard</a>, <a href="/search?value1=Jan+Gerstoft&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gerstoft Jan</a>, <a href="/search?value1=Gitte+Kronborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kronborg Gitte</a>, <a href="/search?value1=Frederik+N+Engsig&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Engsig Frederik N</a></span>. Questioning risk compensation: pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(13):pii=2300451. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.13.2300451" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.13.2300451</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 23 Aug 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 20 Dec 2023 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.13.2300451
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