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Systemic preexposure prophylaxis for HIV: translating clinical data to clinical practice
Julius Li1, Staci L Dufrene, Jason F Okulicz
1South Texas Veterans Health Care System, San Antonio, TX, USA.
The Annals of Pharmacotherapy
|January 30, 2014
Summary
Oral tenofovir-emtricitabine (TDF-FTC) for HIV preexposure prophylaxis (PrEP) shows significant risk reduction in new HIV infections. Judicious use in high-risk groups, with counseling, is key for maximum clinical and financial impact.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- HIV transmission remains a global health challenge despite advances in antiretroviral therapy.
- Oral tenofovir-emtricitabine (TDF-FTC) is a recent biomedical intervention approved for HIV preexposure prophylaxis (PrEP).
Purpose of the Study:
- To evaluate the real-world effectiveness and implementation considerations of oral TDF-FTC for HIV PrEP.
- To highlight the role of pharmacists in PrEP delivery.
Main Methods:
- Literature search of PubMed (1996-2013) and HIV/AIDS conference abstracts (2012-2013).
- Inclusion of original studies and review articles in English, with examination of reference citations.
- Evaluation of randomized studies on TDF-FTC efficacy and safety in at-risk populations.
Main Results:
- Four randomized studies demonstrated significant reductions in new HIV infections with good short-term tolerability.
- TDF-FTC for PrEP was studied within comprehensive prevention programs, including counseling on adherence and risk behaviors.
- Potential limitations include concerns about failure and resistance if PrEP is not integrated with adjunct measures.
Conclusions:
- Optimal clinical and financial impact of PrEP is expected with selective application in high-risk populations.
- Appropriate use of PrEP can further reduce the incidence of new HIV infections.
- Pharmacists play a crucial role in selecting and counseling patients for PrEP.
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