Pre-exposure prophylaxis for the prevention of HIV infection in high risk populations: a meta-analysis of randomized controlled trials.
BACKGROUND
Nearly ten randomized controlled trials (RCTs) of pre-exposure prophylaxis (PrEP) have been completed or are ongoing worldwide to evaluate the effectiveness of PrEP in HIV transmission among HIV-uninfected high risk populations. The purpose of this study was to evaluate the role of PrEP to prevent HIV transmission through a Mata-analysis.


METHODS
A comprehensive computerized literature search was carried out in PubMed, EMbase, Ovid, Web of Science, Science Direct, Wan Fang, CNKI and related websites to collect relevant articles (from their establishment date to August 30, 2013). The search terms were "pre-exposure prophylaxis", "high risk population", "HIV infection", "reduction", "relative risk" and "efficacy". We included any RCT assessing PrEP for the prevention of HIV infection in high risk populations. Interventions of the studies were continuously daily or intermittent doses of single or compound antiretrovirals (ARVs) before HIV exposure or during HIV exposure. A meta-analysis was conducted using Stata 10.0. A random-effects method was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CI) for all studies included.


RESULTS
Seven RCTs involving 14,804 individuals in high risk populations were eligible for this study. The number of subjects in the experimental groups was 8,195, with HIV infection rate of 2.03%. The number of subjects in the control groups was 6,609, with HIV infection rate of 4.07%. The pooled RR was 0.53 (95% CI = 0.40 ∼ 0.71, P<0.001). The re-analyzed pooled RR were 0.61 (95% CI = 0.48 ∼ 0.77, P<0.001), 0.49 (95% CI = 0.38 ∼ 0.63, P<0.001), respectively, by excluding the largest study or two studies without statistical significance. Publication bias analysis revealed a symmetry funnel plot. The fail-safe number was 1,022.


CONCLUSIONS
These results show that PrEP is an effective strategy for reducing new HIV infections in high risk populations.
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Junjun
J
Jiang
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Xiaoyi
X
Yang
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Li
L
Ye
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China.
Bo
B
Zhou
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Chuanyi
C
Ning
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Jiegang
J
Huang
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Bingyu
B
Liang
School of Public Health, Chongqing Medical University, Chongqing, China.
Xiaoni
X
Zhong
School of Public Health, Chongqing Medical University, Chongqing, China.
Ailong
A
Huang
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China.
Renchuan
R
Tao
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China.
Cunwei
C
Cao
Geriatrics Digestion Department of Internal Medicine, The First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi, China.
Hui
H
Chen
Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China ; School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Hao
H
Liang
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000379:methods / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D019380:Anti-HIV Agents