Patterns of Coinfection in PrEP Users: A Systematic Review of Quantitative Evidence

Pre-exposure prophylaxis (PrEP) has significantly advanced HIV prevention efforts worldwide, especially among populations at heightened risk of infection. However, as its adoption expands, so too does the need to understand its broader implications on public health, particularly with regard to sexually transmitted infections (STIs). This thesis systematically reviews and synthesizes quantitative evidence on infection patterns in individuals using this drug, focusing on the incidence and recurrence of non-HIV STIs such as syphilis, gonorrhea, chlamydia, and hepatitis B and C. Special attention is given to the interplay between behavioral risk compensation, diagnostic frequency, and access to healthcare services. Brazil serves as a central point of reference due to its progressive public health policies, notably the large-scale, free distribution of this drug through its national health system since 2017. The country’s extensive and heterogeneous PrEP coverage provides robust data that allows for comprehensive analysis of infection trends. Italy, which has historically had a low uptake of PrEP despite early approval, has only recently approved reimbursement through its national health system. As a result, a significant increase in its users is anticipated. In this context, Brazil offers a valuable comparative model for predicting possible future health scenarios in Italy and other countries with emerging PrEP programs. By aggregating and analyzing data from diverse settings, this study aims to inform clinical guidelines and public health strategies to optimize both prevention and monitoring efforts in the evolving landscape of HIV and STI care.