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Is event-driven PrEP dosing for HIV as effective as daily dosing?
Tory Olsen1, Zachary Lally-Montgomery1, Gary Kelsberg1
1Valley Family Medicine Residency, University of Washington at Valley, Renton.
The Journal of Family Practice
|August 19, 2021
Summary
Event-driven pre-exposure prophylaxis (PrEP) is effective in reducing HIV, with potentially lower adherence but also lower costs and greater patient preference compared to daily PrEP. Further research is needed to directly compare these regimens.
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- Daily pre-exposure prophylaxis (PrEP) is a proven HIV prevention method.
- Event-driven PrEP offers an alternative dosing strategy.
- Direct comparative trials between daily and event-driven PrEP are limited.
Purpose of the Study:
- To compare the efficacy, adherence, cost, and patient preference of event-driven PrEP versus daily PrEP.
- To evaluate the impact of different PrEP dosing regimens on HIV conversion rates.
- To synthesize evidence on the real-world effectiveness and patient acceptance of various PrEP strategies.
Main Methods:
- Review of large randomized controlled trials (RCTs) and prospective cohort studies.
- Analysis of HIV conversion rates, adherence data, medication costs, and patient choice.
- Assessment of the strength of recommendation (SOR) based on study design and evidence quality.
Main Results:
- Event-driven PrEP demonstrated an 86% reduction in HIV conversion versus placebo (SOR: B).
- Daily PrEP showed a 44% to 86% reduction in HIV conversion (SOR: B).
- Event-driven PrEP had lower adherence (70%) compared to daily PrEP (92%) (SOR: B), but lower costs and similar STI rates (SOR: B).
- A significant majority of patients (75%) preferred event-driven PrEP (SOR: BB).
Conclusions:
- Both daily and event-driven PrEP are effective HIV prevention strategies.
- Event-driven PrEP may offer advantages in cost and patient preference despite potential adherence challenges.
- Further head-to-head trials are warranted to definitively compare the two regimens.
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