HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans
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Despite established HIV prevention strategies and broadly available diagnostic strategies in developed western countries, rates of HIV new infections remain high. Alternative strategies for HIV prevention, particularly among men who have sex with men (MSM), are crucial. HIV pre-exposure prophylaxis (PrEP) has been discussed as one additional option that this review seeks to explore.
An online search identifying PrEP-relevant literature from 1st January 2010 to 1st August, 2015 was performed.
The iPrEx study, first published in 2010, demonstrated a reduction in relative risk (RRR) of HIV seroconversion of 44 % for continuous PrEP with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in MSM. The efficacy of PrEP has been confirmed for continuous PrEP in the PROUD study and for intermittent PrEP in the IPERGAY study (RRR = 86 % in both studies). The PrEP was well tolerated in all studies, and the evolution of HIV resistance has been low. Compensatory increased sexual risk behavior was not observed in recent studies. In contrast to the high efficacy of risk reduction for HIV transmission in MSM, the results of TDF PrEP and TDF/FTC PrEP studies using microbicidal agents or pills among heterosexual women were different (RRR 6–75 %).
Continuous and intermittent PrEP demonstrated high efficacy in preventing HIV seroconversion, notably among MSM. PrEP was well tolerated. Adherence was critical for high efficacy in all studies. Further studies to evaluate implementation strategies and cost-effectiveness in different risk populations are needed as well as drug approval in Europe.
KeywordsHIV PrEP Pre-exposure prophylaxis Review
Acquired immunodeficiency syndrome
International AIDS conference
Conference on retroviruses and opportunistic infections
Federal Drug Administration (United States of America)
Human immunodeficiency virus
International AIDS society conference
HIV integrase inhibitor
Intravenous drug abuse(r)
Non-nucleosidic reverse transcriptase inhibitor
Nucleoside reverse transcriptase inhibitor
HIV pre-exposure prophylaxis
Relative risk reduction
Tenofovir disoproxil fumarate/emtricitabine
Tenofovir disoproxil fumarate
Young men having sex with men
Compliance with ethical standards
Conflict of interest
Dr. Christoph D. Spinner received grants for travel and participation in advisory boards of AbbVie, Bristol-Meyers Squibb, Gilead, Janssen-Cilag, MSD, and ViiV. Grants for investigator initiated studies (ISR) from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare were also given. Dr. Christoph Boesecke received Grants for travel and speakers honoraria from AbbVie, Bristol-Myers Squibb, Gilead, Janssen-Cilag, MSD and ViiV Healthcare as well as research Grants from German Center for Infectious Diseases (DZIF), German Liver Foundation, and NEAT ID. Dr. Alexander Zink received travel Grants from AbbVie, Bristol-Meyers Squibb, Gilead Sciences and MSD. Dr. Heiko Jessen received speaker’s honoraria and participated in advisory boards of ViiV Healthcare, AbbVie Deutschland, Bristol-Myers Squibb, and Gilead Sciences. Grants for investigator initiated studies (ISR) from Gilead Sciences, MSD, and ViiV Healthcare were also given. Prof. Dr. Hans-Jürgen Stellbrink received speaker’s honoraria from AbbVie, Gilead Sciences, MSD, Bristol-Myers Squibb, ViiV Healthcare, and Janssen-Cilag. Prof. Dr. Jürgen Rockstroh received speaker’s honoraria and participated in advisory boards of Abbvie, Bionor, Bristol-Meyers Squibb, Gilead Sciences, Janssen-Cilag, MSD, and ViiV. Grants for investigator initiated studies (ISR) from MSD Sharp and Dohme and Gilead were also given. Dr. Stefan Esser received travel grants and participated in advisory boards of AbbVie, Bionor, Bristol-Meyers Squibb, Gilead Sciences, Janssen-Cilag, MSD, and ViiV. Grants for investigator initiated studies (ISR) from AbbVie, Bristol-Meyers Squibb, Gilead Sciences, Janssen-Cilag, MSD Sharp and Dohme, and ViiV Healthcare were also given.
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