Pre-exposure prophylaxis--one more tool for HIV prevention

Area of Science:

• Medical Science
• Infectious Diseases
• Public Health

Background:

• The human immunodeficiency virus (HIV) epidemic has seen significant advances in treatment, with antiretroviral medications enabling longer patient lifespans.
• Despite treatment successes, HIV prevention efforts in the United States have not reduced annual new diagnoses.
• Pre-exposure prophylaxis (PrEP) has emerged as a key focus in HIV prevention research.

Purpose of the Study:

• To review the progress and challenges in HIV prevention, with a specific focus on pre-exposure prophylaxis (PrEP).
• To discuss various HIV prevention trials and their implications for current and future strategies.

Main Methods:

• Review of key HIV prevention trials, including CAPRISA 004, iPrEx, FEMPREP, VOICE, and HPTN 052.
• Analysis of the successes and limitations observed in these trials regarding PrEP efficacy and safety.

Main Results:

• Early trials like CAPRISA 004 and iPrEx demonstrated optimism for PrEP's role in preventing HIV infection.
• Recent trial terminations (FEM-PREP, VOICE arm) have tempered enthusiasm and highlighted challenges.
• Significant questions remain regarding PrEP's optimal use, safety, adherence, drug resistance, and administration methods.

Conclusions:

• PrEP is unlikely to be a standalone solution for HIV prevention.
• Effective HIV prevention requires a comprehensive approach, integrating PrEP with "test-and-treat" strategies, education, STI management, and condom use.