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Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence
1Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington 98104, USA. ccelum@uw.edu
Current Opinion in Infectious Diseases
|December 14, 2011
Summary
Topical tenofovir gel and oral pre-exposure prophylaxis (PrEP) medications like emtricitabine-tenofovir disoproxyl fumarate (FTC/TDF) show promise in preventing HIV-1. Adherence is key to their effectiveness.
Area of Science:
- Infectious Diseases
- Virology
- Public Health
Background:
- Pre-exposure prophylaxis (PrEP) is a critical strategy for HIV-1 prevention.
- Topical and oral antiretroviral formulations are being evaluated for efficacy and safety.
Purpose of the Study:
- To summarize current pre-exposure prophylaxis (PrEP) trials.
- To review the efficacy and future directions of HIV-1 prevention strategies.
Main Methods:
- Review of key clinical trials evaluating topical tenofovir gel and oral antiretrovirals (emtricitabine-tenofovir disoproxyl fumarate [FTC/TDF], tenofovir disoproxyl fumarate [TDF]).
- Analysis of efficacy data based on population, adherence, and formulation.
Main Results:
- Topical tenofovir gel demonstrated significant reductions in HIV-1 and HSV-2 acquisition.
- Oral FTC/TDF showed efficacy in men who have sex with men (MSM) and heterosexual populations, with higher efficacy linked to adherence.
- Efficacy was not observed in two studies of oral FTC/TDF and TDF in African women, with investigations ongoing.
Conclusions:
- Topical tenofovir gel and oral FTC/TDF are effective PrEP options for specific populations.
- Further research is needed to understand the lack of efficacy in certain groups and to develop new PrEP formulations.
- Ongoing research includes longer-acting formulations, intravaginal rings, and novel antiretrovirals.
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