Aktueller Forschungsstand zur HIV-PrEP: HIV-Prävention und Verbreitung anderer STI

Zusammenfassung

Einleitung Eine Infektion mit HIV kann durch die Einnahme einer HIV-Prä-Expositions-Prophylaxe (PrEP) wirksam verhindert werden. Die Einnahme einer PrEP schützt allerdings nicht vor anderen sexuell übertragbaren Infektionen (STI).

Forschungsziele Ziel des vorliegenden Forschungsüberblicks ist die Beantwortung von zwei Fragenkomplexen: 1. Wie verbreitet ist die PrEP, und wie wirkt sie sich auf die HIV-Prävalenz aus? 2. Kommt es im Zuge der PrEP-Einnahme durch möglicherweise vermehrt kondomlosen Sex zu einem epidemiologisch relevanten Anstieg von anderen STI?

Methoden Es wurden eine Literaturrecherche zu Studien zu PrEP, HIV und anderen STI durchgeführt und Meldedaten aus den USA, Großbritannien und Australien sowie eigene Daten aus Deutschland analysiert.

Ergebnisse Sowohl aus den bisher publizierten Daten aus dem Ausland als auch den eigenen Daten aus Deutschland geht hervor, dass sich die PrEP als wirksame HIV-Prophylaxe v. a. unter MSM verbreitet. Gleichzeitig zeigen die Daten, dass es innerhalb der letzten Jahre zu einem starken Anstieg von STI-Diagnosen gekommen ist. Dieser ist jedoch bereits vor der Einführung der PrEP zu beobachten gewesen und geht wahrscheinlich sowohl auf einen Anstieg von kondomlosem Analsex unter MSM als auch auf vermehrte niedrigschwellige Testangebote zurück. Ein kausaler Einfluss der PrEP ist bislang nicht belegt.

Schlussfolgerung Die Prävention anderer STI muss verbessert werden. Verbesserte STI-Testung und Anbindung von PrEP-Nutzer*innen an das medizinische Versorgungssystem bieten die Möglichkeit, den Anstieg von STI wirksam zu begrenzen. Daher ist es wichtig, dass den PrEP-Nutzer*innen – aber nicht nur diesen – regelmäßige kostenlose STI-Tests inklusive Beratung zur Verfügung stehen, wie vom Terminservice- und Versorgungsgesetz (TSVG) seit der zweiten Jahreshälfte 2019 vorgesehen.

Abstract

Introduction Infection with HIV can be effectively prevented by taking HIV pre-exposure prophylaxis (PrEP). However, taking HIV-PrEP does not provide protection against other sexually transmitted infections (STI).

Objectives The aim of this research overview is to answer two questions: 1. How common is PrEP and how does it affect HIV prevalence? 2. Is there an epidemiologically relevant increase in other STI in the course of PrEP intake due to a possible increase in condomless sex?

Methods A literature search on studies on PrEP, HIV and other STI was carried out, and reporting data from the USA, Great Britain and Australia as well as our own data from Germany were analyzed.

Results Both the previously published data from abroad and our own data from Germany show that PrEP is spreading as an effective HIV prophylaxis, especially among MSM. At the same time, the data show that there has been a sharp increase in STI diagnoses in recent years. However, this had already been observed before the introduction of the PrEP and is probably due both to an increase in condomless anal sex among MSM as well as to an increase in low-threshold STI testing. The causal effect of PrEP in this context has not yet been conclusively demonstrated.

Conclusion Improved STI testing and the connection of PrEP users to the medical care system offer the opportunity to effectively limit the increase in STI. It is therefore important that PrEP users – and other populations – have access to regular free STI tests including counselling, as has been provided for in the Terminservice- und Versorgungsgesetz (TSVG) since the second half of 2019.

Schlüsselwörter

HIV-Infektion - HIV-Prävention - Prä-Expositions-Prophylaxe (PrEP) - sexuelles Risikoverhalten - sexuell übertragbare Infektionen

Key words

HIV infection - HIV prevention - pre-exposure prophylaxis (PrEP) - sexually transmitted infections - sexual risk behviour

Fußnoten

⁵ Die 14 im Zuge der Literaturrecherche ermittelten Studien zu PrEP, HIV und anderen STI (siehe Methodenteil) sind im Literaturverzeichnis mit einem Sternchen (*) markiert.

Publication History

Article published online:
13 December 2019

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