PDF(Pubmed)
Abstract：
HIV pre-exposure prophylaxis (PrEP) effectively reduces new HIV diagnoses. High rates of incident bacterial sexually transmitted infections (STIs) have been observed in patients eligible for and adherent to PrEP. Observational studies generally report low long-term retention in PrEP care. Limited data exist on the rates of bacterial STI diagnosis upon re-engagement with PrEP services. We conducted a retrospective chart review within the HIV prevention program of an urban academic medical center in New York City. Eligible patients started PrEP from 2015 to 2019, then resumed PrEP services after a gap in care of at least 180 days. Demographic, clinical, and laboratory data were used to characterize the patient population and rates of bacterial STI diagnosis at re-engagement. In total, 286 patients were identified, with 316 qualifying re-engagement visits. Twenty-nine percent of patients had continued PrEP during the care gap, and 30% reported discontinuing medication due to a perceived change in risk. A new STI was diagnosed at 19% of re-engagement visits. There was no statistically significant difference in rates of new STI between individuals returning on or off PrEP, nor between those with perceived lower risk and those without. Individuals who fall out of PrEP services and subsequently re-engage remain at high risk of bacterial STI during the gap in care, regardless of whether PrEP medication is continued or the patient perceives themselves to be at lower HIV acquisition risk. Providers should strongly encourage patients discontinuing PrEP to remain engaged in sexual health services. Alternatives to clinic-based PrEP care must still include regular bacterial STI screening.
摘要：
HIV暴露前预防（PrEP）可有效减少新的HIV诊断。在符合PrEP条件并坚持PrEP的患者中观察到高发生率的细菌性性传播感染（STIs）。观察性研究通常报告PrEP护理中的长期保留率低。关于重新使用PrEP服务后细菌性传播感染诊断率的数据有限。我们在纽约市城市学术医学中心的HIV预防计划中进行了回顾性图表审查。符合条件的患者从2015年到2019年开始PrEP，然后在至少180天的护理间隔后恢复PrEP服务。人口统计,临床,和实验室数据用于表征患者群体和再次接触时细菌STI诊断率。总的来说,286名患者被确认，有316次合格的重新接触访问。29％的患者在护理缺口期间继续进行PrEP，30%的人报告由于感知到的风险变化而停止用药。在19％的重新参与访问中诊断出了新的性传播感染。在恢复或退出PrEP的个体之间，新的性传播感染率没有统计学上的显着差异，风险较低的人和没有风险的人之间也没有。在护理缺口期间，退出PrEP服务并随后重新参与的个人仍然处于细菌性性传播感染的高风险中，无论是否继续使用PrEP药物或患者认为自己的HIV感染风险较低。提供者应大力鼓励停止PrEP的患者继续从事性健康服务。基于临床的PrEP护理的替代方案仍然必须包括定期的细菌STI筛查。
