Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals

Abstract

Purpose of Review

Pre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation.

Recent Findings

Injectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use.

Summary

On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.

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Fig. 1

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Funding

Matthew R. Beymer was supported by the UCLA Postdoctoral Fellowship Training Program in Global HIV Prevention Research (Currier and Gorbach, PIs); T32MH080634.

Ian W. Holloway and Raphael J. Landovit were supported by the Center for HIV Identification, Prevention, and Treatment (CHIPTS; NIMH grant MH58107) and the UCLA Center for AIDS Research (CFAR; NIAID grant AI028697).

Ian W. Holloway was supported by California HIV/AIDS Research Program (CHRP; grant RP15-LA-007) and the National Center for Advancing Translational Sciences through UCLA (CSTI; grant UL1TR000124). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

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Correspondence to Matthew R. Beymer.

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Matthew R. Beymer, Ian W. Holloway and Craig Pulsipher declare that they have no conflict of interest.

Raphael J. Landovit has received research grants from, and served as a consultant to Gilead Sciences; and served as a consultant to Merck and Co, Inc.

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Beymer, M.R., Holloway, I.W., Pulsipher, C. et al. Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals. Curr HIV/AIDS Rep 16, 349–358 (2019). https://doi.org/10.1007/s11904-019-00450-9

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Keywords

  • Pre-exposure prophylaxis (PrEP)
  • HIV/AIDS
  • On-demand
  • Injectables
  • Microbicide gels
  • Vaginal rings