男男性行为者暴露前预防风险补偿初探

目的 暴露前预防(Pre-exposure prophylaxis, PrEP)指通过口服抗病毒药物的方式预防HIV感染。PrEP使用过程中出现风险行为增加的情况称为PrEP风险补偿。本研究目的在于初步探究重庆地区男男性行为者PrEP风险补偿,及HIV自我检测对相关风险行为的干预情况。方法 于重庆地区招募男男性行为者,给予其舒发泰(恩曲他滨替诺福韦片)作为暴露前预防用药,同时将受试者按1:1分配到HIV自检干预组和对照组,随访6个月后考察自检对PrEP风险补偿的干预情况。结果 研究纳入126名受试者,最终共93名受试者完成研究,其中自检组43名,对照组50名。结果显示,虽然PrEP相关风险行为在研究期间均未显著增加,但随时间的延长,有接受型性行为的人数、与未知HIV感染状况性伴发生无保护肛交的人数和性病新发率均呈上升趋势。此外,随访第3个月和第6个月,自检组安全套使用率低于50%的比例高于对照组外(p=0.035; p=0.043)。结论 重庆地区男男性行为者PrEP相关风险行为在研究期间未呈现显著增加,但部分风险行为随时间延长呈上升趋势。作为HIV预防的方式之一,HIV自我检测也可能存在风险补偿行为,应警惕并加强教育。

Preliminary investigation of risk compensation related to pre-exposure prophylaxis among men who have sex with menLI Yao, HE Xiao-qing, LU Yan-qiu, WAN Yan, ZHANG Lu, CHEN Yao-kai

Objective Pre-exposure prophylaxis (PrEP) refers to the prevention of HIV infection through oral antiviral drugs. PrEP risk compensation refers to the increase in risky behaviors during the period of the usage of PrEP. The present study aims to initially explore the PrEP related risk compensation of men who have sex with men (MSM) and the intervention of human immunodeficiency virus (HIV) self-testing on them in Chongqing. Methods Eligible MSM in Chongqing were recruited. Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate tablets) was prescribed as PrEP drug, and the subjects were assigned as 1:1 and divided into HIV self-testing intervention group and control group. After 6 months of follow-up, the effect of HIV self-testing on PrEP related risk compensation was investigated. Results The study included 126 MSM, and finally a total of 93 of 126 completed the study, 43 of 93 were assigned in the HIV self-testing group and 50 of 93 in the control group. The results showed that in the process of pre-exposure prophylaxis, the risk compensation related high-risk behaviors did not change significantly over time, but the number of people who receive penetrative sexual behavior, the number of people who had unprotected anal sex with their partners with unknown HIV infection, and the rate of new sexual transmitted disease rate displayed an upward trend at the 6th month of follow-up. In addition, the condom use rate in the HIV self-testing group was significantly higher than that of in the control group (p=0.035; p=0.043) at the 3rd and 6th months of follow-up. Conclusion PrEP-related risk behaviors of MSM in Chongqing did not display a significant increase during the study period. But as time wears on, some risk behaviors showed an upward trend. As one of the methods of HIV prevention, HIV self-testing may also have risk compensation behaviors. It should be alert and strengthen education.