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Master Thesis

PrEP en vie réelle : caractéristiques épidémiologiques et incidence des infections sexuellement transmissibles

Abstract : Introduction: we have limited data outside clinical studies for people who started PrEP in France. Our retrospective, multi-center study evaluates epidemiological data at baseline, as well as the incidence of sexually transmitted infections (STIs) during the follow-up of PrEP users. In one of the centers, some of the beneficiaries of PrEP were recruited via a dating application.
Materials and methods: over a period of 26 months, we collected data from patients who initiated PrEP in 3 centers of our department. The prevalence of STIs over the two years before inclusion, and over the study period, as well as the incidence of STIs were calculated for the entire cohort.
Results: from December 1, 2015 to February 28, 2018, 333 people started PrEP. Their median age is 39 years [IQR 30-45], 314 (94%) are MSM, of which 57 (25%) were recruited via the dating application. Among these ones, we did not find any difference in terms of age (p = 0.1746), history of STIs (p = 0.14), condom use (p = 0.50), and drug use (p = 0.78) compared to others. During the follow-up, one HIV infection was diagnosed (0.39 / 100 AP) and 121 patients had at least one STI, that leads to an incidence of 66.28 / 100 AP. We didn't note a difference between the prevalence in the two years before inclusion (41%, [136/333]) and over the study period (36%, [121/333]), p = 0.932. We found a subpopulation of patients (17.1%) that gets more infected and represents 74% of all the STIs. In GRINDR and chemsex users, the incidence of STIs is not significantly different from the rest of the cohort. However, "chemsexeurs" get more infected from the rectum (p = 0.005).
Conclusion: PrEP, poorly known by health workers, disrupts the prevention of HIV infection. Only middle-aged men who have sex with men seem to be aware of it. Despite the absence of an increase in the prevalence of STIs, our study confirms a high rate of STIs, particularly rectal ones. This probably reflects the decrease in condom use, and systematic screening for infections, most of them being asymptomatic. Prophylaxis should be extended to all at-risk groups and all ages through general practitioners and community structures. It provides patients a program including STIs prevention and sexual health.
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Master Thesis
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Sabrina Manni. PrEP en vie réelle : caractéristiques épidémiologiques et incidence des infections sexuellement transmissibles. Médecine humaine et pathologie. 2019. ⟨dumas-02613855⟩

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