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HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans

Abstract

Purpose

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.

Methods

An online search identifying PrEP-relevant literature from 1st January 2010 to 1st August, 2015 was performed.

Results

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 %).

Conclusions

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.

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Fig. 1

Abbreviations

AIDS:

Acquired immunodeficiency syndrome

AIDS:

International AIDS conference

CROI:

Conference on retroviruses and opportunistic infections

FDA:

Federal Drug Administration (United States of America)

HIV:

Human immunodeficiency virus

IAS:

International AIDS society conference

INSTI:

HIV integrase inhibitor

IVDA:

Intravenous drug abuse(r)

NNRTI:

Non-nucleosidic reverse transcriptase inhibitor

NRTI:

Nucleoside reverse transcriptase inhibitor

PrEP:

HIV pre-exposure prophylaxis

RRR:

Relative risk reduction

TAF:

Tenofovir alafenamide

TDF/FTC:

Tenofovir disoproxil fumarate/emtricitabine

TDF:

Tenofovir disoproxil fumarate

TFV:

Tenofovir

YMSM:

Young men having sex with men

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Correspondence to Christoph D. Spinner or Stefan Esser.

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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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Spinner, C.D., Boesecke, C., Zink, A. et al. HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans. Infection 44, 151–158 (2016). https://doi.org/10.1007/s15010-015-0850-2

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  • DOI: https://doi.org/10.1007/s15010-015-0850-2

Keywords

  • HIV
  • PrEP
  • Pre-exposure prophylaxis
  • Review