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Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States.
Clin Infect Dis. 2020 Apr 15; 70(9):1884-1890.CI

Abstract

BACKGROUND

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) decreases HIV transmission. Some studies have raised concerns about a potential association between the implementation of HIV PrEP and the growing incidence rates of sexually transmitted infections (STIs) in the United States.

METHODS

We conducted a quasi-experimental (interrupted time series) analysis of STI (syphilis, gonorrhea, and chlamydia) rates before (2000-2012) and after (2013-2017) the implementation of HIV PrEP. We also performed correlations between HIV PrEP utilization and STI cases at the national (2012-2017) and state (2017) levels. We defined HIV PrEP utilization as the number of people taking tenofovir disoproxil fumarate/emtricitabine for HIV prevention.

RESULTS

HIV PrEP implementation was associated with 25% (relative risk [RR] 1.254, 95% confidence interval [CI] 1.245-1.263; P < .001) and 26% (RR 1.260, 95% CI 1.257-1.264; P < .001) increases in syphilis and gonorrhea rates, respectively, and a 12% reduction in chlamydia rates (RR: 0.884, 95% CI 0.883-0.885; P < .001). HIV PrEP utilization was correlated with the numbers of syphilis, gonorrhea, and chlamydia cases (spearman coefficients 1.00, 0.94, and 0.94, respectively; P < .001, P < .01, and P < .01, respectively). At the state level, HIV PrEP was also correlated with the number of cases of syphilis, gonorrhea, and chlamydia (spearman coefficients 0.85, 0.81, and 0.85, respectively; Ps < .001 for all correlations).

CONCLUSIONS

The implementation and utilization of HIV PrEP in the United States were associated with increased rates of STIs. Further studies to confirm these associations and to elucidate potential causes are needed.

Authors+Show Affiliations

Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine.Department of Managed Care Contracting, Texas Children's Hospital.Department of Finance, Baylor College of Medicine.Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31284300

Citation

Serpa, Jose A., et al. "Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 70, no. 9, 2020, pp. 1884-1890.
Serpa JA, Huynh GN, Nickell JB, et al. Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States. Clin Infect Dis. 2020;70(9):1884-1890.
Serpa, J. A., Huynh, G. N., Nickell, J. B., & Miao, H. (2020). Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 70(9), 1884-1890. https://doi.org/10.1093/cid/ciz552
Serpa JA, et al. Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States. Clin Infect Dis. 2020 Apr 15;70(9):1884-1890. PubMed PMID: 31284300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States. AU - Serpa,Jose A, AU - Huynh,Gabriel N, AU - Nickell,Julie B, AU - Miao,Hongyu, PY - 2019/02/21/received PY - 2019/06/21/accepted PY - 2019/7/10/pubmed PY - 2019/7/10/medline PY - 2019/7/9/entrez KW - HIV KW - chlamydia KW - gonorrhea KW - prevention KW - syphilis SP - 1884 EP - 1890 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 70 IS - 9 N2 - BACKGROUND: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) decreases HIV transmission. Some studies have raised concerns about a potential association between the implementation of HIV PrEP and the growing incidence rates of sexually transmitted infections (STIs) in the United States. METHODS: We conducted a quasi-experimental (interrupted time series) analysis of STI (syphilis, gonorrhea, and chlamydia) rates before (2000-2012) and after (2013-2017) the implementation of HIV PrEP. We also performed correlations between HIV PrEP utilization and STI cases at the national (2012-2017) and state (2017) levels. We defined HIV PrEP utilization as the number of people taking tenofovir disoproxil fumarate/emtricitabine for HIV prevention. RESULTS: HIV PrEP implementation was associated with 25% (relative risk [RR] 1.254, 95% confidence interval [CI] 1.245-1.263; P < .001) and 26% (RR 1.260, 95% CI 1.257-1.264; P < .001) increases in syphilis and gonorrhea rates, respectively, and a 12% reduction in chlamydia rates (RR: 0.884, 95% CI 0.883-0.885; P < .001). HIV PrEP utilization was correlated with the numbers of syphilis, gonorrhea, and chlamydia cases (spearman coefficients 1.00, 0.94, and 0.94, respectively; P < .001, P < .01, and P < .01, respectively). At the state level, HIV PrEP was also correlated with the number of cases of syphilis, gonorrhea, and chlamydia (spearman coefficients 0.85, 0.81, and 0.85, respectively; Ps < .001 for all correlations). CONCLUSIONS: The implementation and utilization of HIV PrEP in the United States were associated with increased rates of STIs. Further studies to confirm these associations and to elucidate potential causes are needed. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31284300/Human_Immunodeficiency_Virus_Pre_exposure_Prophylaxis_and_Increased_Incidence_of_Sexually_Transmitted_Infections_in_the_United_States_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz552 DB - PRIME DP - Unbound Medicine ER -
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