Michael Stuart Bronze，醫學博士 / 2024 年 12 月 12 日
HIV 感染的暴露前預防（PrEP）可以預防新的感染。儘管人們對 PrEP 的認識正在提高，但堅持的障礙仍然存在。儘管有幾種 PrEP 可供選擇，但只有一小部分有 HIV 感染風險且願意服用 PrEP 的人真正這麼做了。由於愛滋病毒的恥辱感和對 PrEP 缺乏認識，教育和鼓勵患者堅持服用 PrEP 對醫療保健提供者來說也是一個挑戰。
您了解有關 PrEP 依從性的最新情況嗎？透過這個快速測驗來測試您的知識。
問題 1/5
對於至少堅持度達80%於 PrEP 療法的人來說，HIV 發病率大約降低了多少？
25%
45%
65%
85%
答案 1/5
對於至少堅持度達80%於 PrEP 療法的人來說，HIV 發病率大約降低了多少？
您的同伴選擇回答的比例：
25%———————-5%
45%———————-5%
65%———————16%
85%———————74%
最近的系統性回顧和統合分析發現，80% 或更高的依從率（被認為是「高依從性」）與依從率較低的人相比，治療效果明顯更高。具體而言，堅持率達到或超過 80% 時，愛滋病毒感染率可降低 86%，而堅持率低於 80% 時，愛滋病毒感染率可降低 45%。對於堅持使用 PrEP 的使用者來說，每日使用 PrEP 和隨選使用 PrEP 的功效相似。
問題 2/5：堅持服用 PrEP 的人比較容易出現哪種副作用？
體重減輕
不可逆的腎功能障礙
骨礦物質密度嚴重損失，骨折風險增加
短期胃腸道症狀
答案 2/5：堅持服用 PrEP 的人比較容易出現哪種副作用？
您的同伴選擇回答的比例：
體重減輕————————————————2%
不可逆的腎功能障礙———————————-3%
骨礦物質密度嚴重損失，骨折風險增加———–12%
短期胃腸道症狀—————————————–83%
根據美國疾病管制與預防中心 (CDC) 的說法，一些堅持每日 PrEP 療法的人可能會出現胃腸道症狀和頭痛的「啟動綜合症」，通常會在 1 個月內消退。 CDC 也提醒臨床醫生監測急性腎損傷的跡象，但已發現 PrEP 使用者的腎功能障礙是輕微的、非進展性的和可逆的。愛滋病教育與訓練中心計畫 PrEP 處方指南指出，服用 PrEP 一年後可能會出現骨礦物質密度輕微下降（1%），但通常不會增加骨折風險。服用 PrEP 的患者也有可能出現體重增加，通常在治療的第一年內就會出現。
問題 3/5：根據最近的數據，有多少比例的男男性行為者 (MSM) 遵守 PrEP？
15%
25%
45%
75%
答案 3/5：根據最近的數據，有多少比例的男男性行為者 (MSM) 遵守 PrEP？
您的同伴選擇回答的比例：
15%————————-9%
25%————————-22%
45%————————-39%
75%————————-30%
對 PrEP 的認識與使用意願和堅持程度有關。根據美國疾病管制與預防中心 (CDC) 統計，93% 的男同性戀和雙性戀男性知道 PrEP，但只有 45% 的人使用它。此外，一項涵蓋超過 20 萬名跨國 MSM 的統合分析發現，58% 的 MSM 了解 PrEP。然而，只有 50% 的研究對象表示他們願意使用準備工作。這種差異與另一項研究的結果相似，研究發現 88% 的參與者知道 PrEP，但只有 66.7% 的參與者願意使用它。此外，表示願意服用該藥物的 MSM 中只有 13% 的人服用了該藥物，而其中只有 44% 的人堅持服用。
問題 4/5：使用卡博特韋(cabotegravir)注射 PrEP 的患者應多久回來進行一次維持注射（第二次注射後）？
每兩週
每2個月
每6個月
每年
答案 4/5：使用卡博特韋(cabotegravir)注射 PrEP 的患者應多久回來進行一次維持注射（第二次注射後）？
您的同伴選擇：
每兩週——————–0%
每2個月——————0%
每6個月——————0%
每年————————0%
PrEP 可以作為每日口服藥物服用，也可以作為長期常規注射劑服用。患者應在第一次服藥後 1 個月回來服用第二次藥物，但此後，維持劑量只需每 2 個月服用一次。 CDC 還建議在這些訪問中安排各種測試和患者評估，包括反覆進行 HIV 測試、篩檢其他性傳播感染以及評估是否繼續進行 PrEP。
問題 5/5：對於 PrEP 依從性的尿液檢測，哪種方法最準確？
它不是商業化的
患者不太接受
它通常用於實現長期堅持
提高依從性
答案 5/5：對於 PrEP 依從性的尿液檢測，哪種方法最準確？
你的同行選擇：
它不是商業化的—————————0%
患者不太接受——————————-0%
它通常用於實現長期堅持—————–0%
提高依從性———————————–0%
儘管尿液收集通常被認為是 PrEP 依從性的短期措施，但一個顯著的優勢是，當向患者提供結果時，它已被證明可以提高 PrEP 依從性。系統性回顧指出，尿液檢測由於這個原因而成為特別有吸引力的選擇，此外它還具有商業化、非侵入性、以及患者廣泛接受的特徵。
還有其他幾種測量依從性的選擇，從藥丸計數到電子依從性監測器甚至頭髮採樣，都有各自的優點和缺點。
以上所表達的任何觀點均為作者本人觀點，不一定反映 WebMD 或 Medscape 的觀點。
引用：快速五項測驗：HIV 暴露前預防（PrEP）依從
Fast Five Quiz: HIV Pre exposure Prophylaxis (PrEP) Adherence
Michael Stuart Bronze, MD / December 12, 2024
Preexposure prophylaxis (PrEP) for HIV infection can prevent new infections. Although awareness of PrEP is increasing, barriers to adherence still exist. Though several PrEP options are available, only a subset of persons at risk for HIV exposure who are willing to take PrEP actually do. Because of the stigma around HIV and lack of awareness of PrEP, educating and encouraging patients to remain adherent can be a challenge for healthcare providers as well.
Do you know the latest on PrEP adherence? Test your knowledge with this quick quiz.
Question 1/5：Approximately what rate reduction of HIV incidence was found in persons who were at least 80% adherent to their PrEP regimen?
25%
45%
65%
85%
Answer 1/5：Approximately what rate reduction of HIV incidence was found in persons who were at least 80% adherent to their PrEP regimen?
Your peers chose:
25%—————5%
45%—————5%
65%—————16%
85%—————74%
A recent systematic review and meta-analysis found that adherence rates of 80% or higher, considered “high adherence,” were associated with significantly higher treatment efficacy compared with persons with lower adherence rates. Specifically, an adherence rate of 80% or above was associated with an 86% rate reduction of incident HIV infection, compared with a 45% rate reduction for those with adherence rate below 80%. Efficacy for adherent users was similar with daily PrEP use and on-demand PrEP.
Question 2/5：Those who adhere to PrEP are more likely to experience which side effect?
Weight loss
Irreversible renal dysfunction
Major bone mineral density loss and increased fracture risk
Short-term gastrointestinal symptoms
Answer 2/5：Those who adhere to PrEP are more likely to experience which side effect?
Your peers chose:
Weight loss—————————————————————————–2%
Irreversible renal dysfunction——————————————————-3%
Major bone mineral density loss and increased fracture risk——————12%
Short-term gastrointestinal symptoms——————————————–83%
According to the Centers for Disease Control and Prevention (CDC), some persons who adhere to a daily PrEP regimen might experience a “start-up syndrome” of gastrointestinal symptoms and headache, which typically resolves within 1 month. CDC also cautions clinicians to monitor for signs of acute renal injury, but renal dysfunction in PrEP users has been found to be mild, nonprogressive, and reversible. The AIDS Education & Training Center Program PrEP prescribing guidelines note that a slight loss of bone mineral density (1%) can occur over 1 year of taking PrEP, but it is generally not associated with an increased risk for fractures. Weight gain is also a possibility for patients taking PrEP and is usually observed within the first year of treatment.
Question 3/5：According to recent data, what percentage of men who have sex with men (MSM) adhere PrEP?
15%
25%
45%
75%
Answer 3/5：According to recent data, what percentage of men who have sex with men (MSM) adhere PrEP?
Your peers chose:
15%————————————9%
25%————————————22%
45%————————————39%
75%————————————30%
Awareness of PrEP is associated with willingness to use and adherence. According to the CDC, 93% of gay and bisexual males are aware of PrEP but only 45% reportedly use it. Further, a meta-analysis comprising over 200,000 multinational MSM found that 58% of MSM were aware of PrEP. However, only 50% of the study population stated they would be willing to use prep. This disparity was similar to that in another study, which found that 88% of participants were aware of PrEP but only 66.7% were willing to use it. Further, only 13% of MSM who said they were willing to take it did, and among those, only 44% adhered to it.
Question 4/5：How often should patients who are using cabotegravir injectable PrEP return for maintenance injections (following their second dose)?
Every 2 weeks
Every 2 months
Every 6 months
Every year
Answer 4/5：How often should patients who are using cabotegravir injectable PrEP return for maintenance injections (following their second dose)?
Your peers chose:
Every 2 weeks———————————0%
Every 2 months——————————–0%
Every 6 months——————————–0%
Every year—————————————0%
PrEP can be taken as a daily oral pill, but it can also be taken as a long-term routine injection. Patients should return for their second dose 1 month after their first dose, but thereafter, maintenance doses need to be given only once every 2 months. The CDC also recommends a schedule of various tests and patient assessments at these visits, including recurrent HIV tests, screening for other sexually transmitted infections, and assessment of desire to continue PrEP.
Question 5/5：Which is most accurate regarding urine testing for PrEP adherence?
It is not commercially available
It is not well accepted by patients
It is routinely used to achieve long-term adherence
It improves adherence
Answer 5/5：Which is most accurate regarding urine testing for PrEP adherence?
Your peers chose:
It is not commercially available————————————–0%
It is not well accepted by patients———————————–0%
It is routinely used to achieve long-term adherence————-0%
It improves adherence————————————————-0%
Although urine collection is usually considered a short-term measure of adherence to PrEP, a significant advantage is that is has been shown to increase PrEP adherence when results are given to patients. A systematic review noted that urine testing is an especially attractive option for this reason, in addition to it being commercially available, noninvasive, and well accepted by patients.
Several other options for measuring adherence are available, from pill counts to electronic adherence monitors and even hair sampling, all with their own advantages and disadvantages.
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Fast Five Quiz: HIV Pre exposure Prophylaxis (PrEP) Adherence – Medscape – Dec 12, 2024.
