PrEP Use Might Increase the Risk for STIs

HIV preexposure prophylaxis (PrEP) use may be associated with a higher risk for sexually transmitted infections (STIs), according to new research from Australia.

“[These] findings suggest the importance of frequent testing for STIs among gay and bisexual men using PrEP,” the researchers wrote, who were part of the Pre-exposure Prophylaxis Expanded (PrEPX) Study team.

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To conduct the PrEPX Study, the researchers followed 2981 participants enrolled at 5 ACCESS (Australian Collaboration for Coordinated Enhanced Sentinel Surveillance) clinics from baseline (July 26, 2016 – April 1, 2018) to April 30, 2018.

The participants included gay and bisexual men at high risk for HIV infection and were included in the analysis if they had at least 1 follow-up visit at the 5 ACCESS centers.

At baseline, the participants were prescribed daily oral tenofovir disoproxil fumarate and emtricitabine for HIV PrEP, received quarterly HIV and STI testing, and received clinical monitoring.

After a mean 1.1 years of follow-up, 1434 participants had developed chlamydia, 1242 had developed gonorrhea, and 252 had developed syphilis.

“In this longitudinal study of 2981 mostly gay and bisexual men who received daily HIV preexposure prophylaxis, STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STIs,” the researchers concluded.

“Among 1378 participants with preenrollment STI testing data available, receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with preenrollment (adjusted incidence rate ratio, 1.12).”

In the multivariate analysis, younger age, greater partner number, and group sex were all associated with a higher risk for STIs. However, condom use was not associated with a higher risk.

—Amanda Balbi

Reference:

Traeger MW, Cornelisse VJ, Asselin J, et al; PrEPX Study Team. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. 2019;321(14):1380-1390. doi:10.1001/jama.2019.2947.