Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis

• Published in: Clinical infectious diseases Vol. 67; no. 5; pp. 676 - 686
• Main Authors: Traeger, Michael W, Schroeder, Sophia E, Wright, Edwina J, Hellard, Margaret E, Cornelisse, Vincent J, Doyle, Joseph S, Stoové, Mark A
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16.08.2018
• Subjects: human immunodeficiency virus; pre-exposure prophylaxis; sexual behavior; sexually transmitted infections; risk compensation
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy182

This systematic review and meta-analysis of 17 open-label studies published to 2017 found that daily HIV pre-exposure prophylaxis use among men who have sex with men is associated with increased sexually transmitted infection diagnoses and an increase in condomless sex. Abstract Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM. Methods We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed. Results Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users. Conclusion Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.