title: The European preexposure prophylaxis revolution.
abstract: OBJECTIVE
  The review describes the European epidemic and the challenges in moving from clinical trials of preexposure prophylaxis (PrEP) to routine practice.
  
  
  RESULTS
  Two European trials conducted in gay and other MSM and transgender women reported a high and consistent reduction in HIV incidence using oral PrEP with tenofovir/emtricitabine (TDF/FTC). The incidence of HIV infection in the control group was much higher than anticipated, based on routine surveillance data in MSM, in spite of the highest standard of HIV prevention available.
  
  
  CONCLUSIONS
  Recent results have highlighted the urgent need to make PrEP available to key populations in Europe as an additional prevention tool. Gilead has not yet submitted an application to use TDF/FTC as PrEP in Europe. Although regulatory approval would accelerate implementation, countries are already dispensing TDF/FTC as postexposure prophylaxis without this. Services for prevention are diverse across countries ranging from free, walk-in services for the diagnosis and treatment of HIV and other sexually transmitted infections, to insurance-dependent reimbursement of private clinical services. Momentum is gathering in Europe with PrEP demonstration projects in MSM and a growing demand from community organizations. Each Member State urgently needs to identify their key populations and determine the service best placed to provide this new prevention strategy within a comprehensive prevention package.
authors.affiliation: aNAM Publications/Aidsmap.com, London, UK bEuropean AIDS Treatment Group, Brussels, Belgium cMedical Research Council Clinical Trials Unit at UCL, University College London, London, UK dINSERM U941, University of Paris Diderot, Sorbonne Paris Cité eDepartment of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.
authors.forename: Gus
authors.initials: G
authors.lastname: Cairns
authors.forename: Sheena
authors.initials: S
authors.lastname: McCormack
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D000068679:Emtricitabine / Q000008:administration & dosage; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis / Q000379:methods* / Q000458:organization & administration*; D000068698:Tenofovir / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine