Study On The Relationship Between Pre-exposure Prophylaxis And Sexually Transmitted Infections In High-risk Population Of HIV Infection

Objective:Pre-exposure prophylaxis(PrEP)is a new and effective biological prevention method to prevent Human Immunodeficiency Virus(HIV)by oral antiviral drugs.At present,a number of clinical studies around the world have proved that PrEP can effectively prevent new HIV infection in men who have sex with men(MSM).In 2019,51 countries and regions around the world have issued guidelines on the use of PrEP in adults to prevent HIV infection.However,oral PrEP may lead to"risk compensation",that is,an increase in sexually transmitted infections(STIs)through changes in sexual behavior.In order to solve this problem,there are no studies at home and abroad to determine whether oral PrEP can lead to the increase of STIs,and there is still a lack of pre-exposure drug guidance program suitable for our national conditions.This study conducted a systematic review and meta-analysis by searching the relevant literature,in order to objectively and systematically explore the relationship between the use of PrEP and the incidence of sexually transmitted infections,further comprehensive evaluation,and explore how to better use PrEP to benefit those people at high risk of HIV infection.It also provides a reference basis for relevant domestic guidelines and prevention strategies,and contributes to the further containment of the epidemic of HIV in high-risk groups and the prevention of sexually transmitted infections.Methods:In this systematic review and meta-analysis,we first formulated a retrieval strategy with the keywords of"HIV","AIDS","PrEP"and"STI"related subject words and free text,comprehensively searched the Pub Med,Web of Science and Cochrane Library databases,obtained the research data of observational studies and open trials from January1960 to September 2019,and made an extraction table.The extracted data were statistically analyzed by Revman5.3 software or Stata15.0 software,and the results of longitudinal comparison between PrEP and non-PrEP control and PrEP cohort were evaluated.The main results were sexually transmitted infections,and the secondary results were high-risk sexual behaviors.I~2statistics were used to estimate the heterogeneity of the results.Random effect model or fixed effect model was used to analyze and calculate the combined effect odds ratio(OR)or relative risk(RR).The corresponding results were discussed.Results:A total of 1092 studies were retrieved and finally included in 37 studies after independent screening by two researchers,of which 24 studies,including 18275participants,reported the prevalence of sexually transmitted infections,which could be extracted and analyzed.including data from 14 observational studies,5 randomized,placebo-controlled trials and 5 open-label trials.The remaining 13 studies reported changes in sexual behavior.The total incidence of sexually transmitted infections was 29%(14%～46%;P<0.0001;I~2=99%).The prevalence rate of venereal diseases after follow-up was slightly higher than the baseline(38%,95%CI,30%～46%;P<0.00001 VS 30%,95%CI,22%～37%;P<0.00001).After follow-up,the RR compared with the baseline was1.30(95%CI,0.92～1.84;P=0.13).PrEP may not lead to an increase in overall sexually transmitted infections(odds ratio[OR]=1.44;95%confidence interval[CI],0.98～2.11;P=0.06).PrEP was significantly associated with rectal chlamydia infection(OR,1.55;1.13～2.12;P=0.006),urethral chlamydia infection(OR,3.04;1.64～5.63;P=0.0004),and urethral gonorrhea diagnosis(OR,2.74;1.35～5.55;P=0.005).We also found that the increase in sexually transmitted infections may be related to the increase in the frequency of testing(OR,3.02;95%CI,1.69～5.4;P=0.0002).In the study of sexual behavior,most studies have shown that the number of PrEP users who have no condom sex has increased and the number of sexual partners has decreased.Conclusion:Our study shows that oral PrEP does not lead to a significant increase in total STIs compared with non-oral PrEP,emphasizing the importance of oral PrEP.We suggest promoting the use of PrEP in high-risk groups of HIV infection.However,the overall incidence of sexually transmitted infections is still high,and the total incidence of sexually transmitted infections in the same population is higher than that of non-oral PrEP for a period of time.Some sexually transmitted infections such as gonorrhea and chlamydia trachomatis/mycoplasma infections still increase,and sexually transmitted infections will increase with the increase in the frequency of testing,so we still recommend regular surveillance of sexually transmitted diseases in high-risk groups.