用多西环素 (DoxyPEP) 进行暴露后预防,以在现实环境中预防性传播感染:PRIDOX研究
R Palacios1,2, C Gómez-Ayerbe1,2, S Martín-Cortés1,2
1Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain.
多西环素暴露后预防 (DoxyPEP) 显著降低了在接受PrEP的高风险MSM中Chlamydia trachomatis和梅毒的发生率. 在现实环境中,DoxyPEP表现出良好的耐受性和安全性,没有观察到多药耐药细菌的增加.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 性传播感染 (STIs) 仍然是一个重大的公共卫生问题,特别是在与男性发生性关系的男性 (MSM) 使用HIV暴露前预防 (PrEP) 中.
- 多西环素暴露后预防 (DoxyPEP) 已成为制性传播疾病发病率的潜在策略,但对其有效性和安全性的现实数据至关重要.
研究的目的:
- 评估DoxyPEP在接受HIV PrEP的高风险MSM队列中对Chlamydia trachomatis (CT),Neisseria gonorrhoeae (NG) 和梅毒 (SPL) 的发病率的影响.
- 评估DoxyPEP在这个人群中的安全性和耐受性,并监测多药耐药 (MDR) 细菌的出现.
主要方法:
- 一项前性队列研究,涉及2023年3月至2024年8月期间感染性传播疾病的高风险HIV PrEP用户.
- CT,NG和SPL的发病率在DoxyPEP前期和DoxyPEP后期之间使用Cox的比例危险模型进行了比较.
- 对NG和MDR细菌进行了培养,并进行了抗生素敏感性测试.
主要成果:
- 在876名PrEP使用者中,197人开始使用DoxyPEP (98.4%的MSM).
- 多克西培显著降低了CT的发病率 (31.4到7.8每100人/年,P<0.001) 和SPL的发病率 (21.5到3.2每100人/年,P<0.001).
- 对NG没有观察到显著的减少 (41.5到28.9每100人年,P=0.1). NG分离物仍然对 ceftriaxone 敏感,而四环素耐药性与对照物相比较. MDR细菌的流行率保持稳定.
结论:
- 在常规PrEP护理中,DoxyPEP得到了很好的接受,并显著降低了性传播感染的发病率,在现实环境中证明了它的有效性和安全性.
- 该研究没有观察到MDR细菌或耐药NG菌株在DoxyPEP使用时增加.
- 需要进一步的研究,以充分了解DoxyPEP对细菌耐药性和人类微生物群的长期影响.
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