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
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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. / von Schreeb, Sebastian; Pedersen, Susanne Kriegel; Christensen, Hanne; Jørgsensen, Kristina Melbardis; Harritshøj, Lene Holm; Hertz, Frederik Boetius; Ahlström, Magnus Glindvad; Lebech, Anne Mette; Lunding, Suzanne; Nielsen, Lars Nørregaard; Gerstoft, Jan; Kronborg, Gitte; Engsig, Frederik N.
In: Eurosurveillance, Vol. 29, No. 13, 2300451, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Questioning risk compensation
T2 - pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022
AU - von Schreeb, Sebastian
AU - Pedersen, Susanne Kriegel
AU - Christensen, Hanne
AU - Jørgsensen, Kristina Melbardis
AU - Harritshøj, Lene Holm
AU - Hertz, Frederik Boetius
AU - Ahlström, Magnus Glindvad
AU - Lebech, Anne Mette
AU - Lunding, Suzanne
AU - Nielsen, Lars Nørregaard
AU - Gerstoft, Jan
AU - Kronborg, Gitte
AU - Engsig, Frederik N.
N1 - Publisher Copyright: © 2024 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
U2 - 10.2807/1560-7917.ES.2024.29.13.2300451
DO - 10.2807/1560-7917.ES.2024.29.13.2300451
M3 - Journal article
C2 - 38551099
AN - SCOPUS:85189135379
VL - 29
JO - Eurosurveillance
JF - Eurosurveillance
SN - 1025-496X
IS - 13
M1 - 2300451
ER -
ID: 387994878