Recent advances in pre-exposure prophylaxis for HIV

Abstract

Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.

Study on Pre-Exposure Prophylaxis Regimens among Men Who Have Sex with Men: A Prospective Cohort Study

“…The PrEP regimen mainly includes the use of tenofovir disoproxil fumarate (TDF) monotherapy or a combination of TDF and emtricitabine (FTC) (also known as Truvada) [3]. The effectiveness and safety of a long-term use of TDF or TDF/FTC for preventing new HIV-1 infections have both been confirmed in healthy people [4][5][6][7][8]. However, no comparative studies have been conducted on the use of TDF monotherapy in the MSM population; prior studies have focused on comparing between daily TDF and TDF/FTC regimens or between event-driven TDF/FTC and daily TDF/FTC regimens among MSM.…”

Hepatitis C virus incidence in HIV‐infected and in preexposure prophylaxis (PrEP)‐using men having sex with men

“…Preexposure prophylaxis (PrEP) of HIV with antiretroviral drugs is a prevention tool targeting populations at high risk of HIV infection, especially MSM . Acute HCV infections have been reported in PrEP‐using MSM, and a recent study based on a typing and phylogenetic cluster analysis suggested HCV transmission from HIV‐infected to HIV‐negative subjects .…”

Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 - Time is Now

“…Pharmaceutical antivirals are not only potentially therapeutic but have been successfully applied pre-and post-exposure as prophylaxis against viral infections such as influenza (Oxford, 2007), human immunodeficiency virus (HIV) (Desai et al, 2017), cytomegalovirus (Hussein et al, 2020), and respiratory syncytial virus (Rezaee et al, 2017). Using influenza as a model for preventive management of respiratory viral pandemics, the key concerns are surges in community attack rates and healthcare system demand (Nap et al, 2007) , which in turn lead to disruptions in healthcare with potentially disastrous social and economic ramifications.…”