男男性行为者暴露前预防风险补偿初探

Preliminary exploration of pre-exposure prophylaxis risk compensation among men who have sex with men

目的探究重庆地区男男性行为者暴露前预防(PrEP)风险补偿情况及HIV自检对相关风险行为的干预情况。方法于2018年6月至2019年6月招募重庆地区男男性行为者,以恩曲他滨替诺福韦片作为Pr EP用药,通过抽签将受试者按1∶1随机分配到HIV自检组和对照组,随访6个月考察HIV自检对PrEP风险补偿的干预情况。结果共纳入126名受试者,最终有93人完成研究,其中HIV自检组43人、对照组50人。PrEP相关风险行为在随访期间均未明显增加,但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及性病新发率均呈上升趋势。此外,随访第3、6个月时HIV自检组安全套使用率<50%的受试者比例均高于对照组(P=0.035、0.043)。结论重庆地区男男性行为者PrEP相关风险行为在随访6个月内未明显增加,但部分风险行为呈上升趋势。HIV自检的男男性行为者可能存在风险补偿行为,应引起警惕并加强警示教育。

Objective To explore the pre-exposure prophylaxis(PrEP)risk compensation of men who have sex with men(MSM)and the intervention of human immunodeficiency virus(HIV)self-testing on relevant risk behaviors in Chongqing.Methods Eligible MSM were recruited in Chongqing from Jun.2018 to Jun.2019.Truvada(Emtricitabine and Tenofovir Disoproxil Fumarate tablets)was prescribed as the PrEP drug of choice,and the subjects were randomly assigned at a ratio of 1∶1(by drawing lots)into HIV self-testing intervention group and control group.After 6 months of follow-up,the effect of HIV self-testing on PrEP risk compensation was investigated.Results A total of 126 subjects were included,and 93 eventually completed the study,including 43 in the HIV self-testing group and 50 in the control group.There was no significant increase in PrEP related risk behaviors during the follow-up period,but the number of participants who were engaged in receptive penetrative sex,the number of participants who had unprotected anal sex with partners having unknown HIV status,and the incident rate of new sexually transmitted diseases all showed an increasing trend.In addition,the proportions of subjects with condom use rate<50% in the HIV self-testing group were significantly higher than those 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 do not show a significant increase at 6 months of follow-up.However,some risk behaviors show an upward trend.MSM who use HIV selftesting may have risk compensation behaviors,which should be alerted and education should be strengthened.