Pre-Exposure Prophylaxis for the Prevention of HIV Infection in High Risk Populations: A Meta-Analysis of Randomized Controlled Trials

Jiang, Junjun; Yang, Xiaoyi; Li, Ye; Zhou, Bo; Ning, Chuanyi; Huang, Jiegang; Liang, Bingyu; Zhong, Xiaoni; Huang, Aiping; Tao, Renchuan; Cao, Cunwei; Chen, Hui; Liang, Hao

doi:10.1371/journal.pone.0087674

Cited by 61 publications

(43 citation statements)

References 35 publications

(32 reference statements)

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“…139 Early PrEP trials in Cambodia failed to launch due to ethical, political, and logistical concerns raised by civil society leaders during 2004, [140][141][142] and initiation of the Bangkok Tenofovir PrEP study was delayed for several years. 143 Two clinical trials of oral PrEP for HIV-negative individuals conducted in Thailand showed a reduction in HIV acquisition in MSM 144 and in PWID 143 ( Results of the PROUD study and of the on-demand (before and after sexual intercourse) ''Ipergay'' PrEP study showed a relative reduction of 86% in the incidence of HIV acquisition among MSM.…”

Section: Preexposure Prophylaxis (Prep) and Microbicidesmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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Section: Preexposure Prophylaxis (Prep) and Microbicidesmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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“…Developing HIV prevention options that women can use therefore remains a global concern, given the soaring rates of HIV infection among women. Preexposure prophylaxis (PrEP), in which HIV uninfected persons with ongoing HIV risk use antiretroviral medications as chemoprophylaxis against sexual HIV acquisition, is a promising new HIV prevention strategy [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Kiweewa¹,

Mugwanya²,

FrancisKiweewa³

2017

HIV/AIDS - Contemporary Challenges

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There is a daunting challenge to prevent human immunodeiciency virus (HIV) acquisition in women at high risk of acquiring HIV. Of the 37 million people globally living with HIV, more than half are women. Women account for nearly 60% of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While male condoms are efective, they are not always used, and this is not something women can control. Women urgently need prevention tools they can decide to use, independent of a husband or partner. Pre-exposure prophylaxis (PrEP), in which HIV-uninfected persons with ongoing HIV risk use antiretroviral (ARV) medications as chemoprophylaxis against sexual HIV acquisition, is a promising new HIV prevention strategy. We review recent advances in the development of new biomedical HIV prevention interventions with a highlight of indings from pivotal clinical trials, as well as a discussion on future generation strategies for women.

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“…40,41 A recent meta-analysis of seven PrEP randomized controlled trials demonstrated an overall risk reduction of 47% confirming previous findings. 42,43 PrEP research is evolving with 17 ongoing studies 44 assessing the efficacy of PrEP in new populations (adolescents at high risk and transgender), development of new drug delivery systems, formulations with longer half-life, and open-label extension of prior efficacy trials. 45 The approval of Truvada (oral tenofovir disoproxyl fumarate and emtricitabine) for PrEP by the US Food and Drug Administration (FDA) in 2012 46 and the release of guidelines by WHO [47][48][49] and CDC 50,51 recommending PrEP for certain populations represented a significant biomedical Contribute to the design of the scientific agenda, manufacture and supply products to be tested in humans and work on access and licensure with national public health and regulatory authorities Media Newspapers, TV, radio, internet, newsletters…”

Section: Pre-exposure Prophylaxismentioning

confidence: 99%

Stakeholder Engagement in HIV Cure Research: Lessons Learned from Other HIV Interventions and the Way Forward

Chu

Ananworanich

et al. 2015

AIDS Patient Care and STDs

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Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders.

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Pre-Exposure Prophylaxis for the Prevention of HIV Infection in High Risk Populations: A Meta-Analysis of Randomized Controlled Trials

Cited by 61 publications

References 35 publications

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Stakeholder Engagement in HIV Cure Research: Lessons Learned from Other HIV Interventions and the Way Forward

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