Encyclopedia of AIDS

Living Edition
| Editors: Thomas J. Hope, Douglas Richman, Mario Stevenson

Preexposure Prophylaxis (PrEP)

Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-9610-6_126-1

Definition and Rationale for Preexposure Prophylaxis (PrEP)

Traditionally, HIV prevention methods have focused on approaches such as education, evidence-based behavioral modifications, prevention with positives, harm reduction, and consistent condom use. Given that there are an estimated 7,000 new HIV infections globally each day, an estimated 48,000 new infections in the United States annually, and lack of success in developing an HIV vaccine thus far, these approaches have had a limited impact on stemming the HIV epidemic. Therefore, recent efforts have focused on the use of biomedical prevention methods to reduce HIV incidence.

Preexposure prophylaxis for HIV or “PrEP” is a biomedical prevention method that involves HIV-negative persons using oral or topical antiretroviral medications prior to sexual or parenteral exposure to prevent HIV. PrEP is seen as an intervention that should complement existing HIV prevention strategies. It is one of several biomedical prevention methods,...

Keywords

Placebo Toxicity Insurance Coverage Diarrhea Malaria 
This is a preview of subscription content, log in to check access

References

  1. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74. Erratum in: Science. 2011;333(6042):524.PubMedCentralCrossRefPubMedGoogle Scholar
  2. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.PubMedCentralCrossRefPubMedGoogle Scholar
  3. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, et al. A case–control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med. 1997;337(21):1485–90.CrossRefPubMedGoogle Scholar
  4. Centers for Disease Control and Prevention (CDC). Preliminary results from first safety study of daily tenofovir for HIV prevention among MSM find no significant concerns [media summary]; 2010 July 23. Available from: http://www.cdc.gov/nchhstp/newsroom/MSMPrEPMediaSummary.html
  5. Centers for Disease Control and Prevention (CDC). Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60(3):65–8.Google Scholar
  6. Centers for Disease Control and Prevention (CDC). Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2012;61(31):586–9.Google Scholar
  7. Choopanya K, Martin M, Suntharasamia P, Sangkum U, Mock PA, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomized, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083–90.CrossRefPubMedGoogle Scholar
  8. Cohen MS, Muessig KE, Smith MK, Powers KA, Kashuba AD. Antiviral agents and HIV prevention: controversies, conflicts, and consensus. AIDS. 2012;26(13):1585–98.PubMedCentralCrossRefPubMedGoogle Scholar
  9. Cong ME, Youngpairoj AS, Zheng Q, Aung W, Mitchell J, Sweeney E, et al. Protection against rectal transmission of an emtricitabine-resistant simian/human immunodeficiency virus SHIV162p3M184V mutant by intermittent prophylaxis with Truvada. J Virol. 2011;85(15):7933–6.PubMedCentralCrossRefPubMedGoogle Scholar
  10. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O-Sullivan MJ, et al. Reduction of maternal infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS clinical trials group protocol 076 study group. N Engl J Med. 1994;331(18):1173–80.CrossRefPubMedGoogle Scholar
  11. Dobard C, Sharma S, Parikh U, Hanson D, Lipscomb J, Novembre F, et al. High protection against vaginal infection in macaques by PEP with gel containing RAL [abstract]. In: CROI 2011 – 18th Conference on Retroviruses and Opportunistic Infections; 2011 Feb 27–Mar 5; Boston. Abstract 30. Available from: http://www.retroconference.org/2011/Abstracts/41607.htm
  12. García-Lerma JG, Otten RA, Qari SH, Jackson E, Cong M, Masciotra S, et al. Prevention of rectal SHIV transmission in macaques by daily or intermittent prophylaxis with emtricitabine and tenofovir. PLoS Med. 2008;5(2):e28.PubMedCentralCrossRefPubMedGoogle Scholar
  13. García-Lerma JG, Cong M, Mitchell J, Youngpairoj AS, Zheng Q, Masciotra S, et al. Intermittent prophylaxis with oral Truvada protects macaques from rectal SHIV infection. SciTransl Med. 2010;2(14):14ra14–4.Google Scholar
  14. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.PubMedCentralCrossRefPubMedGoogle Scholar
  15. Grohskopf L, Gvetadze R, Pathak S, O’Hara B, Mayer K, Liu A, et al. Preliminary analysis of biomedical data from the phase II clinical safety trial of tenofovir disoproxil fumarate (TDF) for HIV-1 pre-exposure prophylaxis (PrEP) among U.S. men who have sex with men (MSM) [abstract]. In: AIDS 2010 – XVIII International AIDS Conference; 2010 July 18–23; Vienna. Abstract FRLBC102. Available from: http://www.iasociety.org/Default.aspx?pageId=11&abstractId=200741348
  16. Hurt CB, Eron Jr JJ, Cohen MS. Pre-exposure prophylaxis and antiretroviral resistance: HIV prevention at a cost? Clin Infect Dis. 2011;53(12):1265–70.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Leibowitz AA, Parker KB, Rotheram- Borus MJ. A US policy perspective on oral preexposure prophylaxis for HIV. Am J Public Health. 2011;101(6):982–5.PubMedCentralCrossRefPubMedGoogle Scholar
  18. Liu AY, Vittinghoff E, Chillag K, Mayer K, Thompson M, et al. Sexual risk behavior among HIV-uninfected men who have sex with men participating in a tenofovir preexposure prophylaxis randomized trial in the United States. J Acquir Immune Defic Syndr. 2013;64(1):87–94.PubMedCentralCrossRefPubMedGoogle Scholar
  19. Lorente N, Fugon L, Carrieri MP, Andreo C, Le Gall JM, Cook E, et al. Acceptability of an “on-demand” pre-exposure HIV prophylaxis trial among men who have sex with men living in France. AIDS Care. 2012;24(4):468–77.PubMedGoogle Scholar
  20. Marrazzo J, Ramjee G, Nair G, et al. Pre-exposure prophylaxis for HIV in women: daily oral tenofovir, oral tenofovir/emtricitabine or vaginal tenofovir gel in the VOICE study (MTN 003) [abstract]. In: CROI 2013 – 20th Conference on Retroviruses and Opportunistic Infections; 2013 Mar 3–6; Atlanta. Abstract 26LB. Available from: http://www.retroconference.org/2013b/Abstracts/47951.htm
  21. Microbicide Trials Network (MTN). Microbicide Trials Network statement on decision to discontinue use of tenofovir gel in VOICE, a major HIV prevention study in women [media statement]; 2011 Nov 25. Available from: http://www.mtnstopshiv.org/node/3909
  22. Mutua G, Sanders E, Mugo P, Anzala O, Haberer JE, Bangsberg D, et al. Safety and adherence of intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PLoS One. 2012;7(4):e33103.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Paltiel AD, Freedberg KA, Scott CA, Schackman BR, Losina E, Wang B, et al. HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806–15.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Parikh UM, Dobard C, Sharma S, Cong M, Jia H, Martin A, et al. Complete protection from repeated vaginal simian-human immunodeficiency virus exposures in macaques by a topical gel containing tenofovir alone or with emtricitabine. J Virol. 2009;83(20):10358–65.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Peterson L, Taylor D, Roddy R, Belai G, Phillips P, Nanda K, et al. Tenofovir disoproxil fumarate for prevention of HIV infection in women: a phase 2, double-blind, randomized, placebo-controlled trial. PLoS Clin Trials. 2007;2(5):e27.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.CrossRefPubMedGoogle Scholar
  27. Underhill K, Operario D, Skeer MR, Mimiaga MJ, Mayer KH. Packaging PrEP to prevent HIV: an integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice. J Acquir Immune Defic Syndr. 2010;55(1):8–13.PubMedCentralCrossRefPubMedGoogle Scholar
  28. United States Food and Drug Administration (U.S. FDA). FDA approves first medication to reduce HIV risk [consumer update]; 2012 July 16. Available from: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm
  29. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2014: a clinical practice guideline. http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Accessed 3 Nov 2015
  30. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.PubMedCentralCrossRefPubMedGoogle Scholar
  31. Veazey R, Ketas T, Dufour J, et al. Protection of rhesus macaques from vaginal infection by maraviroc, an inhibitor of HIV-1 entry via the CCR5 co-receptor. J Infect Dis. 2010;202(5):739–44.PubMedCentralCrossRefPubMedGoogle Scholar
  32. Walensky RP, Park JE, Wood R, Freedberg KA, Scott CA, Bekker LG, et al. The cost-effectiveness of pre-exposure prophylaxis for HIV infection in South African women. Clin Infect Dis. 2012;54(10):1504–13.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Epidemiology and BiostatisticsThe George Washington University Milken Institute School of Public HealthWashingtonUSA