Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis.
Open accessAbstract
Background: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM. Methods: We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed. Results: Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users. Conclusion: Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Studies have reported that MSM taking PrEP have high rates of STIs, and frequent screening is warranted.
“Studies have reported that MSM taking PrEP have high rates of STIs, and frequent screening is warranted (204–206).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [204]
The Discussion reports increased STI diagnoses and high rates of repeat diagnoses among MSM using PrEP, supporting the claim about STI rates. The paper calls for efforts to minimize STIs, but the passages found do not specifically recommend frequent STI screening. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., Goicochea, P., Casapía, M., Guanira-Carranza, J. V., Ramirez-Cardich, M. E., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1011205 · Cited by 5,096 · see citing works
Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.
Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., Tappero, J. W., Bukusi, E. A., Cohen, C. R., Katabira, E., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1108524 · Cited by 3,256 · see citing works
McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., Sullivan, A. K., Clarke, A., Reeves, I., Schembri, G., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00056-2 · Cited by 1,878 · see citing works
On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection
Molina, J., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., Tremblay, C. L., Gall, J.-M. L., Cua, É., Pasquet, A., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1506273 · Cited by 1,633 · see citing works
Choopanya, K., Martin, M., Suntharasamai, P., Sangkum, U., Mock, P. A., Leethochawalit, M., Chiamwongpaet, S., Kitisin, P., Natrujirote, P., Kittimunkong, S., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61127-7 · Cited by 1,463 · see citing works
Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., Hosek, S., Mosquera, C., Casapía, M., Montoya, O., et al. (2014) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(14)70847-3 · Cited by 1,204 · see citing works
Effectiveness and safety of oral HIV preexposure prophylaxis for all populations
Fonner, V. A., Dalglish, S. L., Kennedy, C. E., Baggaley, R. C., O’Reilly, K., Koechlin, F. M., Rodolph, M., Hodges-Mameletzis, I., & Grant, R. M. (2016) · AIDS · doi:10.1097/qad.0000000000001145 · Cited by 991 · see citing works
Publication bias: evidence of delayed publication in a cohort study of clinical research projects
Stern, J. M., & Simes, R. J. (1997) · BMJ · doi:10.1136/bmj.315.7109.640 · Cited by 818 · see citing works
Liu, A. Y., Cohen, S. E., Vittinghoff, E., Anderson, P. L., Doblecki-Lewis, S., Bacon, O., Chege, W., Postle, B. S., Matheson, T., Amico, K. R., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.4683 · Cited by 602 · see citing works
Volk, J. E., Marcus, J. L., Phengrasamy, T., Blechinger, D., Nguyen, D. P., Follansbee, S., & Hare, C. B. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ778 · Cited by 489 · see citing works
Meta-analysis of multiple outcomes: a multilevel approach
Van den Noortgate, W., López-López, J. A., Marín-Martínez, F., & Sánchez-Meca, J. (2015) · Behavior Research Methods · doi:10.3758/s13428-014-0527-2 · Cited by 450 · see citing works
Degenhardt, L. J., Mathers, B. M., Vickerman, P. T., Rhodes, T., Latkin, C. A., & Hickman, M. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60742-8 · Cited by 423 · see citing works
Marcus, J. L., Hurley, L. B., Hare, C. B., Nguyen, D. P., Phengrasamy, T., Silverberg, M. J., Stoltey, J. E., & Volk, J. E. (2016) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001129 · Cited by 286 · see citing works
An HIV Preexposure Prophylaxis Demonstration Project and Safety Study for Young MSM
Hosek, S., Rudy, B. J., Landovitz, R. J., Kapogiannis, B. G., Siberry, G. K., Rutledge, B. N., Liu, N., Brothers, J., Mulligan, K. M., Zimet, G. D., et al. (2016) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001179 · Cited by 267 · see citing works
Early Experiences Implementing Pre-exposure Prophylaxis (PrEP) for HIV Prevention in San Francisco
Liu, A., Cohen, S. E., Follansbee, S., Cohan, D., Weber, S., Sachdev, D. D., & Buchbinder, S. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001613 · Cited by 250 · see citing works
Kojima, N., Davey, D. J., & Klausner, J. D. (2016) · AIDS · doi:10.1097/qad.0000000000001185 · Cited by 195 · see citing works
High Interest in Preexposure Prophylaxis Among Men Who Have Sex With Men at Risk for HIV Infection
Cohen, S. E., Vittinghoff, E., Bacon, O., Doblecki‐Lewis, S., Postle, B. S., Feaster, D. J., Matheson, T., Trainor, N., Blue, R. W., Estrada, Y. A., et al. (2014) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000479 · Cited by 190 · see citing works
Martin, J. N., Roland, M. E., Neilands, T. B., Krone, M., Bamberger, J. D., Kohn, R. P., Chesney, M. A., Franses, K., Kahn, J. S., Coates, T. J., et al. (2004) · AIDS · doi:10.1097/00002030-200403260-00010 · Cited by 153 · see citing works
Lal, L., Audsley, J., Murphy, D., Fairley, C. K., Stoove, M. A., Roth, N., Moore, R. D., Tee, B. K., Puratmaja, N., Anderson, P. L., et al. (2017) · AIDS · doi:10.1097/qad.0000000000001519 · Cited by 117 · see citing works
Self-citationFrequent Transmission of Gonorrhea in Men Who Have Sex with Men
Fairley, C. K., Hocking, J. S., Zhang, L., et al. (2016) · Emerging infectious diseases · doi:10.3201/eid2301.161205 · Cited by 108 · see citing works
Chan, P. A., Glynn, T. R., Oldenburg, C. E., Montgomery, M. C., Robinette, A., Almonte, A. A., Raifman, J., Mena, L. A., Patel, R. R., Mayer, K. H., et al. (2016) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000000514 · Cited by 86 · see citing works
Will Risk Compensation Accompany Pre-Exposure Prophylaxis for HIV?
Blumenthal, J. S., & Haubrich, R. (2014) · The AMA Journal of Ethic · doi:10.1001/virtualmentor.2014.16.11.stas1-1411 · Cited by 85 · see citing works
Beymer, M. R., DeVost, M. A., Weiss, R. E., Dierst-Davies, R., Shover, C. L., Landovitz, R. J., Beniasians, C., Talan, A. J., Flynn, R. P., Krysiak, R. C., et al. (2018) · Sexually Transmitted Infections · doi:10.1136/sextrans-2017-053377 · Cited by 78 · see citing works
Oldenburg, C. E., Nunn, A. S., Montgomery, M., Almonte, A., Mena, L., Patel, R. R., Mayer, K. H., & Chan, P. A. (2018) · AIDS and Behavior · doi:10.1007/s10461-017-1701-1 · Cited by 76 · see citing works
Wright, E., Grulich, A. E., Roy, K., Boyd, M. A., Cornelisse, V. J., Russell, D. B., O’Donnell, D., Whittaker, B., Crooks, L., & Zablotska, I. (2017) · Journal of Virus Eradication · doi:10.1016/s2055-6640(20)30338-1 · Cited by 71 · see citing works
Self-citationFrankis, J. S., Young, I., Flowers, P., & McDaid, L. M. (2016) · PLoS ONE · doi:10.1371/journal.pone.0151385 · Cited by 65 · see citing works
Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV
Holt, M., & Murphy, D. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.303930 · Cited by 58 · see citing works
Voetsch, A. C., Heffelfinger, J. D., Begley, E. B., et al. (2007) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181576874 · Cited by 49 · see citing works
Chow, E. P. F., Walker, S. M., Hocking, J. S., Bradshaw, C. S., Chen, M. Y., Tabrizi, S. N., Howden, B. P., Law, M. G., Maddaford, K., Read, T. R. H., et al. (2017) · BMC Infectious Diseases · doi:10.1186/s12879-017-2541-3 · Cited by 44 · see citing works
Self-citationDoyle, J., Degenhardt, L. J., Pedrana, A. E., McBryde, E. S., Guy, R., Stoove, M. A., Weaver, E. R., Grulich, A. E., Lo, Y.-R. J., & Hellard, M. E. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu602 · Cited by 36 · see citing works
Self-citationMalekinejad, M., Parriott, A. M., Blodgett, J. C., Horváth, H., Shrestha, R. K., Hutchinson, A. B., Volberding, P. A., & Kahn, J. G. (2017) · PLoS ONE · doi:10.1371/journal.pone.0180718 · Cited by 26 · see citing works
P-01-066 PrEP in Montreal: Good Adherence, No Seroconversion and No Evidence of Risk Compensation
Thomas, R., Galanakis, C., Vézina, S., et al. (2016) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2016.03.217 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 12
- Blumenthal J, Haubrich R. Risk compensation in PrEP: an old debate emerges yet again. Virtual Mentor 2014; 16:909-15.
- Reeves BC, Deeks JJ, Higgins JPT, Wells GA. Chapter 13: Including non-ran- domized studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: http://handbook-5-1.cochrane.org/chapter_13/13_including_ non_randomized_studies.htm. Accessed 1 June 2017.
- Colby D, Kongkabpan M, Teeratakulpisarn S, et al. Safety and efficacy of tenofo- vir disoproxil fumarate plus emtricitabine for HIV pre-exposure prophylaxis in Thailand. In: Program and abstracts of the Asia Pacific Conference on AIDS and Co-infections, Hong Kong, 2016.
- Corales R, Holt S, Chen SR, et al. PrEP in the real world: implementation of PrEP in a medium-sized city Community Health Clinic. In: Prgoram and abstracts of the 8th IAS Conference on HIV Pathogenesis Treatment and Prevention, Vancouver, Canada, 2015.
- Elsesser SA, Biello KB, Taylor SW, Tomassilli JC, Safren SA, Mayer KH. Absence of sexual behavioral disinhibition in a PrEP adherence trial: considerations for medical providers who prescribe PrEP for men who have sex with men (MSM). In: Program and abstracts of the 8th IAS Conference on HIV Pathogenesis Treatment and Prevention, Vancouver, Canada, 2015.
- Gulob SA, Pena S, Boonrai K, Douglas N, Hunt M. STI data from communi- ty-based PrEP implementation suggest changes to CDC guidelines. In: Program and abstracts of the Conference on Retroviruses and Opportunistic Infections (CROI), Boston, Massachusetts, 2016.
- Milam J, Jain S, Moore D, et al. Risk compensation among men who have sex with men (MSM) in Southern California following the initiation of pre-exposure prophylaxis (PrEP). In: Program and abstracts of the 8th IAS Conference on HIV Pathogenesis Treatment and Prevention, Vancouver, Canada, 2015.
- Montano MA, Dombrowski JC, Barbee LA, Golden MR, Khosropour CM. Changes in sexual behavior and sti diagnoses among msm using Prep in Seattle, WA. In: Program and abstracts of the Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, Washington, 2017.
- Zablotska I, Vaccher S, Bloch M, et al. No HIV infections despite high-risk behaviour and STI incidence among gay/bisexual men taking daily pre-exposure prophylaxis (PrEP): the PRELUDE demonstration project. In: Program and abstracts of the 9th IAS Conference on HIV Science, Paris, France, 2017.
- Mera R, Magnuson D, Trevor H, Bush S, Rawlings K, McCallister S. Changes in truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States: (2012-2016). In: Program and abstracts of the 9th IAS Conference on HIV Science, Paris, France, 2017.
- Lockwood J, Asselin J, Mak A, et al. Health systems and study design features permitting rapid enrolment of individuals at high-risk of HIV acquisition into a pre-exposure prophylaxis study in Melbourne, Victoria, Australia. In: Program and abstracts of the 9th IAS Conference on HIV Science, Paris, France, 2017.
- Molina JM, Charreau I, Chidiac C, et al. On demand post exposure prophylaxis with doxycycline for MSM enrolled in a PrEP trial. In: Program and abstracts of the Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, US, 2017.
Cited by
Sorted by citations
Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
US Preventive Services Task Force, Owens, D. K., Davidson, K. W., Krist, A. H., Barry, M. J., Cabana, M., Caughey, A. B., Curry, S. J., Doubeni, C. A., Epling, J. W., et al. (2019) · JAMA · doi:10.1001/jama.2019.6390 · Cited by 312 · see citing works
Ong, J. J., Baggaley, R. C., Wi, T. E., Tucker, J. D., Fu, H., Smith, M. K., Rafael, S., Anglade, V., Falconer, J., Ofori-Asenso, R., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.17134 · Cited by 173 · see citing works
Confronting Rising STIs in the Era of PrEP and Treatment as Prevention
Ramchandani, M. S., & Golden, M. R. (2019) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00446-5 · Cited by 84 · see citing works
Lockart, I., Matthews, G. V., & Danta, M. (2019) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000000515 · Cited by 37 · see citing works
Tang, E. C., Vittinghoff, E., Philip, S. S., Doblecki-Lewis, S., Bacon, O., Chege, W., Coleman, M. E., Elion, R., Buchbinder, S., Kolber, M. A., et al. (2020) · AIDS · doi:10.1097/qad.0000000000002522 · Cited by 31 · see citing works
Price, J. C., McKinney, J. E., Crouch, P.-C., Dillon, S. M., Radix, A., Stivala, A., Carollo, J. R., & Fierer, D. S. (2019) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiy670 · Cited by 29 · see citing works
- Authors
- Traeger, M. W., Schroeder, S. E., Wright, E. J., Hellard, M. E., Cornelisse, V. J., Doyle, J. S., & Stoové, M. A.
- Affiliations
- Burnet Institute (AU)
- The Alfred Hospital (AU)
- Disease Elimination Program, Public Health Discipline, Burnet Institute
- Corresponding author
- Traeger, Michael W
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-03-02
- Volume
- 67
- Issue
- 5
- Pages
- 676-686
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2791308891
- Cited by
- 447
- References
- 35
- Citations by year
- 2026: 30 · 2025: 29 · 2024: 53 · 2023: 46 · 2022: 64 · 2021: 63 · 2020: 65 · 2019: 76 · 2018: 20
- FWCI
- 8.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Monash University Research Portal (Monash University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- HIV pre-exposure prophylaxis, men who have sex with men, transgender women, sexual risk behavior, risk compensation, condom use, sexually transmitted infections, rectal chlamydia, unprotected sex, HIV prevention
- MeSH terms
- Sexual and Gender Minorities, Clinical Trials as Topic, Humans, Male, Risk-Taking, Sexual Behavior, Sexual Partners, HIV Infections, Incidence, Condoms, Homosexuality, Male, Anti-HIV Agents, Safe Sex, Unsafe Sex, Observational Studies as Topic, Pre-Exposure Prophylaxis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
