Does the Prep cause a resurgence of the TSIs?

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Question asked from 03/03/2019

Good morning,

Prep is a prevention protocol designed to protect against possible HIV infections. It is a daily or discontinuous medication and regular medical monitoring (every 3 months). It is intended for adults at high risk of contracting HIV, including men who have sex with men (MSM).

Its effectiveness is demonstrated, if the treatment is well followed. This drug was reimbursed by social security in France from 1 January 2016, it was the subject of a communication campaign by the Aides association in July 2018. The laboratory that developed the drug of Prep (Truvada) was one of the donors of the association until 2017 and for "less than 0.5% of the budget"He says helpers.

Read also: AIDS: the "Prep" within the reach of the world

Your question is about the link between Prep and sexually transmitted infections (STIs) other than AIDS. Prep only protects against HIV.

In the show Télématin February 27, Professor Eric Caumes questions the link between the aspect of Prep and the increase in IST (also called STD). "The resurgence of sexually transmitted diseases in the homosexual community is mainly due to a relaxation of the precautions. One might ask what is the role in this context of the Prep. […] One has the impression that there is a sort of replacement of the use of condoms with the use of the Prep. While on the one hand the condom protects against all sexually transmitted diseases and on the other hand the Prep, protects only against HIV infectionHe says.

A statement that reacted to the Aides association.

A resurgence of the STI before the Prep

ISTs have been increasing in France since at least the early 2000s (before the start of Prep) and have increased significantly between MSMs. In 2016, Public Health France noted that "cIn MSM, the progression of the number of gonococcal infections and Chlamydia trachomatis anorectal infections continues. On the other hand, the number of syphilis cases diagnosed in this population does not increase in 2016 […] In heterosexuals, there is a continuous increase in the number of gonorrhea, but a stabilization of syphilis and urogenital infections of Chlamydia trachomatis".

Evolution of the number of gonorrhea for sexual orientation, network of doctors Resist, France, 2004-2016

Public Health France does not declare itselfnot yet able to analyze the effect of Prep on the epidemiology of sexually transmitted diseases".

Likewise, there is still a long way to go to quantify Prep's impact on the evolution of HIV in France. According to the latest data available, in 2016, 6,000 people discovered their HIV status, including 2,600 MSM – in stasis – and 3,200 heterosexuals – a number that continues to decline especially among men.

IDU: drug injectors

It should be noted that 10,405 people have started a Prep between January 2016 and June 2018, of which more than half (almost 5,500) since July 2017.

An expert debate

The links between the Prep and the resurgence of the STIs are current and necessarily recent research topics. The results are therefore preliminary. We mention some international studies.

A 2016 study analyzed existing scientific literature and concluded that Prep MSM users would be 44 times more likely to obtain syphilis than MSM who did not take Prep. The rates are 25 times for gonorrhea and 11 times for chlamydia.

These results should be taken with caution due to methodological biases. As the study authors state, as Prep users are recruited by people who engage in risky sexual behavior as regards exposure to HIV, they are also more susceptible to sexually transmitted diseases. .

Read also: The Prep, a pill to enjoy without obstacles?

Sexually transmitted infections develop due to pre-existing risk practices at the Prep. Will this last increase the incidence of these diseases? Some scientists expect an opposite effect. According to a screening of the Center for Disease Control in the United States in 2017 and according to a German study in 2018, the Prep could reduce the transmission of sexually transmitted infections (up to 40%) even in case of decline in the use of condom.

Such as? With regular medical monitoring that detects faster infection carriers and treats them before they contaminate other people. An argument that does not convince Eric Caumes, for whom "prevention is better than cureAnd who invokes in particular the promotion of sexual practices "saferIn an editorial from September 2018.

Read also: "Ultimately, preparation can be positive in the fight against all sexually transmitted diseases"

The increase in ISTs is old, proven and worrisome. The impact of the Prep's arrival on their dynamics remains to be clarified but could theoretically be positive as negative. New data could emerge from the Conference on Retroviruses and Opportunistic Infections (CROI), to be held in Seattle from 4 to 7 March 2019.

Sincerely

Olivier Monod

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