The mainstay of PrEP therapy, pre
exposure prophylaxis therapy, is Truvada. Composed of two medications used to
treat HIV, tenofovir and emtricitabine, Truvada is approved for daily use to help
prevent an HIV negative person from getting HIV through sexual contact or
injection drug use. When used daily, it has been shown to reduce transmission
of HIV up to 99% (Anderson). PrEP therapy has been shown to reduce the risk of
HIV through sex for gay and bisexual men, transgender women, and heterosexual
men and women, as well as injection drug users (Kagan).
Undoubtedly this is a great
advancement for the HIV Epidemic that the world is facing to date. However, it
does not come without consequence. Some authors have voiced concern regarding
the behavioral disinhibition of PrEP therapy. Simply put, do PrEP users’
perception on decreased risk of HIV infection lead to riskier sexual practices
and increased transmission of sexually transmitted infections (Barreiro)?
Traeger et al recently set out to
describe STI incidence and behavioral risk factors among gay and bisexual men
receiving PrEP therapy. STIs being screened for consisted of chlamydia,
gonorrhea, and syphilis. Among the 2981 mostly gay and bisexual men receiving
PrEP, STI incidence was 91.9 per 100 person-years, with 736 participants (25%)
accounting for 2237 (76%) of all STI’s (Traeger).
Others disagree with the risk
compensation fear associated with PrEP therapy (Rojas), stating that STIs and
HIV can’t be looked at in a box; they need more interdisciplinary perspectives
and long-term evidence cohorts. Either way, no one can argue that scheduling
routine STI testing on PrEP therapy would be a poor choice in management.
Tara Rakiewicz DUCOM 2020
Anderson, Peter L., et al. “Emtricitabine-Tenofovir
Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with
Men.” Science Translational Medicine, American Association for the
Advancement of Science, 12 Sept. 2012,
stm.sciencemag.org/content/4/151/151ra125.full.
Barreiro, Pablo. “Hot News: Sexually Transmitted
Infections on the Rise in PrEP Users.” AIDS Reviews, U.S. National
Library of Medicine, 2018, www.ncbi.nlm.nih.gov/pubmed/29628512.
Kagan, Rachael, and David Evans. “Love May Have Another
Protector.” PrEP, San Francisco Department of Public Health,
prepfacts.org/prep/the-basics/.
Rojas Castro D, Delabre RM,
Molina JM. Give PrEP a chance: moving on from the "risk
compensation"
concept. J Int AIDS Soc. 2019;22 Suppl 6(Suppl Suppl 6):e25351.
doi:10.1002/jia2.25351Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV Preexposure Prophylaxis With
Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA. 2019;321(14):1380–1390. doi:10.1001/jama.2019.2947
