Using preexposure prophylaxis, losing condoms? Preexposure prophylaxis promotion may undermine safe sex

Alaei, Kamiar; Paynter, Christopher A.; Juan, Shao-Chiu; Alaei, Arash

doi:10.1097/qad.0000000000001262

Cited by 40 publications

(27 citation statements)

References 17 publications

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“…Recurrent syphilis infection in PLWH can be interpreted as an indicator of altered sexual risk behaviour. Recently, the increased use of pre‐exposure prophylaxis for HIV has raised concerns about greater risk behaviour among MSM and the possibility that this causes a higher incidence in STIs or HPV‐mediated malignancies . The positive correlation between syphilis, HPV infection and AIN highlights the importance of regular STD screening in PLWH and the benefit of promoting safe sex education.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Todorova

Schwierzeck

Turek

et al. 2019

Acad Dermatol Venereol

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Background Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non‐AIDS‐defining cancer types such as anal carcinoma has become a priority in managing PLWH today. Objective We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort. Methods People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow‐up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t‐test and Mann–Whitney U‐test, as appropriate. Results In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively. Conclusion Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.

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Section: Discussionmentioning

confidence: 99%

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Todorova

Schwierzeck

Turek

et al. 2019

Acad Dermatol Venereol

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“…The possibility exists that increasing rates of bacterial STI observed among MSM [81, 82] may be associated with increased PrEP use [83]. However, the earliest rises in incident bacterial STI preceded the availability of PrEP by several years in those areas where PrEP has become widely available, and rising STI incidence has also been observed in regions where PrEP had was not been made widely available.…”

Section: Emerging Challengesmentioning

confidence: 99%

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

Hoornenborg

Krakower

Prins

et al. 2017

Aids

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“…For example, one in five men who participated in an online survey in Australia reported that they would be willing to engage in condomless anal sex with an HIV positive partner as long as that partner was taking HIV treatments (Bavinton et al., 2016). Finally, as condom use declines, individuals will more likely be exposed to other sexually transmitted infections (STI) which could increase risks for HIV transmission (Alaei, Paynter, Juan, & Alaei, 2016). …”

Section: Introductionmentioning

confidence: 99%

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

et al. 2017

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Community-wide awareness that ART provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same Gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005–2006 (the 2006 survey over-sampled African Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.

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Using preexposure prophylaxis, losing condoms? Preexposure prophylaxis promotion may undermine safe sex

Cited by 40 publications

References 17 publications

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

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