Profilaxia Pré-Exposição da Infeção pelo VIH e Infeções sexualmente transmissíveis - a experiência de um centro Português

Abstract

Background: Human immunodeficiency virus (HIV) Pre-exposure prophylaxis (PrEP) is indicated for individuals at increased risk of acquiring this infection. Since the introduction of this measure, several studies have reported a decrease in condom use and an increase in other sexually transmitted infections (STIs) among PrEP users. This study aims to characterize, socio-demographically and clinically, the population followed at the PrEP appointment and to estimate the incidence of STIs after starting PrEP. Methods: Retrospective cohort study of individuals evaluated at the PrEP appointment Infectious Diseases Service of Centro Hospitalar Universitário de São João, between May 2018 and September 2021. Follow-up involved regular testing for HIV, hepatitis C virus, Treponema pallidum, Neisseria gonorrhoea and Chlamydia trachomatis. Results: 296 subjects were included, with a mean age of 32 years (standard deviation 9 years), of which 256 were men (86,5%). Two hundred and fifty-one (84,8%) were men who have sex with men and 41 (13,9%) were sex workers. The prevalence of STIs diagnosed in the first evaluation was 34,4%, with anal infection by Chlamydia trachomatis being the most prevalent (27,7%). Two hundred and twenty-four individuals (75,6%) started PrEP, with a median follow-up of 9 months (interquartile range 13,5 months). The incidence of STIs was 74,3 / 100 person-years (95% CI, 66,4 - 86,4). Infections caused by Chlamydia trachomatis were the most incident 25,7 / 100 people - year (95% CI, 19,5 - 33,1). Conclusion: The prevalence of STIs in this population is very high. The PrEP appointment allows an active screening for STIs, with a special impact on the diagnosis of asymptomatic individuals and on the research of extragenital infections. The identification of individuals at risk and their appropriate referral, as well as the reinforcement of health education strategies throughout the follow-up are crucial and should be reinforced in higher risk subgroups.