On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection

Act, Abstr; Capitant, Catherine; Spire, Bruno; Pialoux, Gilles; Cotte, Laurent; Charreau, Isabelle; Tremblay, Cécile; Cua, Éric; Pasquet, A.; Raffi, François; Pintado, Claire; Chidiac, Christian; Chas, Julie; Charbonneau, P.; Delaugerre, Constance; Suzan‐Monti, Marie; Loze, Bénédicte; Peytavin, Gilles; Chéret, Antoine; Timsit, Julie; Girard, Gabriel; Lorente, Nicolas; Préau, Marie; Thompson, David R.; Rozenbaum, Willy; Doré, Véronique; Marchand, Lucie; Simon, Christine L.; Etien, N; Meyer, Laurence

doi:10.1056/nejmoa1506273

Cited by 1,326 publications

(1,269 citation statements)

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“…PID and other reproductive tract complications 389 Routine data about diagnoses on discharge from hospital have shown declining trends in PID 390 and ectopic pregnancy during periods of increasing chlamydia testing and increasing 391 chlamydia diagnosis rates in several countries. [115][116][117][118][119][120][121] Ecological associations between 392 chlamydia testing and PID need careful interpretation.…”

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confidence: 99%

Sexually transmitted infections: challenges ahead

Unemo

Bradshaw

Hocking

et al. 2017

The Lancet Infectious Diseases

534

439

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confidence: 99%

Sexually transmitted infections: challenges ahead

Unemo

Bradshaw

Hocking

et al. 2017

The Lancet Infectious Diseases

534

439

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“…The FDA approved expanded Truvada's® indication in 2012 as safe and effective daily oral medication to reduce the risk of sexually acquired HIV infection, a form of pre-exposure prophylaxis (PrEP). PrEP studies (iPrEX, PROUD, Ipergay, and Kaiser) have reported efficacy ranging from 42% to 99% with adherence strongly correlated with effectiveness [5][6][7][8][9]. Side effects in some patients include diarrhea, nausea, liver toxicity, and bone mineral density loss.…”

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confidence: 99%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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“…The clear and substantial benefit of PrEP has been shown in a number of studies [1][2][3] , with estimates of approximately 80% reductions in HIV-infections among those using PrEP 3 . Tenofovir disoproxil fumarate (TDF) and emtricitabine are currently the only recommended combination due to lack of data on other combinations 4 .…”

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confidence: 99%

“…Data from Molina et al 3 suggest the number needed to treat to benefit (no HIV-infection) was 18, and the number needed to treat to harm (grade 2+ proteinuria) was 143. Although the benefit clearly outweighs the harm, it is worth emphasising that the number needed to treat to harm will be significantly lower in those aged > 40, or with poorer renal function at starting PrEP, as illustrated by Gandhi et al (ref), where the chance of a single CrCl < 70 was significantly higher.…”

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confidence: 99%