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Recent advances in pre-exposure prophylaxis for HIV
Monica Desai1, Nigel Field2, Robert Grant3
1HIV and STI Department, Public Health England, London NW9 5EQ, UK.
BMJ (Clinical Research Ed.)
|December 13, 2017
Summary
Pre-exposure prophylaxis (PrEP) with emtricitabine-tenofovir disoproxil fumarate is highly effective and safe for HIV prevention. However, challenges in access and adherence remain critical public health concerns.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Pre-exposure prophylaxis (PrEP) offers a promising strategy for HIV prevention.
- Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) has demonstrated high efficacy across diverse populations and exposure types.
Purpose of the Study:
- To review the evidence on the effectiveness, safety, and risk compensation associated with PrEP.
- To identify remaining public health challenges and disparities in PrEP access.
Main Methods:
- Systematic review of existing studies on PrEP effectiveness and safety.
- Analysis of adherence data and its impact on public health benefits.
- Examination of population-level data regarding risk compensation and STI incidence.
Main Results:
- Oral FTC-TDF is highly effective and safe, with minimal adverse effects on kidney, bone, or pregnancy outcomes.
- Adherence to PrEP varies significantly, impacting its overall public health benefit.
- No evidence of reduced effectiveness due to risk compensation has been observed.
Conclusions:
- PrEP is a safe and effective HIV prevention tool, but access remains limited and unequal.
- Addressing disparities in access based on race and sex is crucial.
- Defining optimal combination prevention strategies requires consideration of local epidemiology, service delivery, and cost-effectiveness.
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