Pre-exposure prophylaxis: a useful tool to prevent human immunodeficiency virus infection?
The aim of preventive measures against human immunodeficiency virus (HIV) is to reduce the incidence of HIV infection in the general population and in high-risk groups, such as men having sex with men (MSM), and to reduce the risk that a given individual will contract or spread the virus. Male and female condoms, post-exposure prophylaxis and circumcision are preventive methods currently recognized or promoted worldwide. Although modest success has been reported in a phase-III vaccine trial, other methods are being evaluated, such as vaginal and rectal microbicides, and pre-exposure prophylaxis (PrEP). Herein, we discuss results from prevention trials, especially those focusing on PrEP and particularly on recent results from 'on-demand' PrEP regimens. The efficacy of PrEP (rates of 0%-86%) is strongly correlated with adherence and plasma concentrations of antiretrovirals. Adverse events are rare. Selection of emtricitabine-resistant strains is mainly reported in individuals with an undiagnosed HIV infection using PrEP. PrEP is now strongly recommended in WHO prevention programmes for individuals at substantial risk for HIV with a view to controlling this epidemic by 2030.
Service de Maladies Infectieuses, Hôpital Tenon, APHP, Paris, France; Université Pierre et Marie Curie, Paris, France. Electronic address: gilles.pialoux@aphp.fr.
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Pialoux
Laboratoire de Virologie, Hôpital Saint Louis, APHP, Paris, France.
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Delaugerre
Hôpital de la Croix Rousse, Centre Hospitalier et Universitaire de Lyon, France.
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Cotte
CHU de Nantes, France.
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Raffi
Departement de Maladies Infectieuses, Hôpital de l'Archet, Centre Hospitalier de Nice, France.
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Cua
INSERM U941, IUH, Hôpital Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, France; Service de Maladies Infectieuses, Hôpital Saint Louis, APHP, Paris, France.
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Molina
D000818:Animals; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018890:Chemoprevention; D002986:Clinical Trials as Topic; D004195:Disease Models, Animal; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis; D016896:Treatment Outcome
D019380:Anti-HIV Agents
Adherence; Human immunodeficiency virus; Pre-exposure prevention; Resistance; Tenofovir/emtricitabine