Personalizing prevention: Advances in pharmacotherapy for HIV prevention

Area of Science:

• Infectious Diseases
• Pharmacology
• Public Health

Background:

• The HIV epidemic disproportionately affects minority groups, highlighting persistent health disparities.
• Pre-exposure prophylaxis (PrEP) is a vital biomedical intervention to prevent new HIV infections among high-risk individuals.
• Despite decreasing incidence, targeted prevention strategies remain essential.

Purpose of the Study:

• To review current medication therapies for HIV pre-exposure prophylaxis (PrEP).
• To examine the personalization of PrEP for diverse patient populations.
• To discuss emerging PrEP medications, treatment as prevention (TasP), and post-exposure prophylaxis (PEP).

Main Methods:

• Review of available literature on PrEP medications and ongoing clinical trials.
• Analysis of current PrEP options including oral, injectable, and vaginal ring formulations.
• Exploration of novel agents under development for HIV prevention.

Main Results:

• Four primary PrEP medications are available: FTC/TDF, FTC/TAF, CAB-LA, and DPV-VR.
• FTC/TAF lacks indication for vaginal exposure prevention; DPV-VR is WHO-endorsed but not US-available.
• Emerging agents include lenacapavir, islatravir, and VRC01, offering new mechanisms and resistance profiles.

Conclusions:

• PrEP is highly effective in preventing HIV infection in at-risk populations.
• Optimal PrEP selection requires consideration of patient-specific factors, cost, and access.
• Personalized prevention strategies, including patient preferences, are key to improving adherence and care retention.