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Connie Celum and Jared M. Baeten
Introduction from the paper:
In spite of substantial progress in scale-up of antiretroviral therapy (ART) for HIV treatment, new infections outpace the number of infected persons initiating ART. A recent trial, HPTN 052, definitively demonstrated that ART substantially reduces risk of HIV transmission, in the context of intensive counseling on risk reduction and viral load monitoring. Policymakers are considering implications of translating HPTN 052 findings into programmatic priorities. Studies in diverse settings have highlighted challenges in achieving linkages to HIV care with high uptake and retention, which is essential to achieve the durable viral suppression that results in reduced HIV infectiousness. Thus, there remains a need to also identify and implement evidence-based primary HIV-prevention strategies, including antiretrovirals (ARVs) for primary HIV prevention as preexposure prophylaxis (PrEP). During the past year, studies demonstrating proof of concept of topical and oral PrEP have reported results. This review will focus on the rationale for PrEP, design of human PrEP studies, recent indings from PrEP efficacy trials, and remaining questions and uncertainties.
Proof of concept has been demonstrated for tenofovir-based topical and oral PrEP for primary prevention. The remaining trials and analyses need to be completed to have a more thorough understanding of the effectiveness in different populations and the relationship between adherence and efficacy. Demonstration projects in populations in which PrEP has been found to be effective are needed to evaluate targeted implementation and cost-effectiveness of PrEP. Effective HIV prevention requires choices of primary prevention strategies such as topical and oral PrEP, and scale-up of secondary prevention including ART for HIV-infected persons. Although the public health impact of PrEP is anticipated to be greater with identification of effective products and delivery systems with sustained coverage, targeted provision of daily and oral tenofovirbased PrEP to populations at high risk of HIV acquisition should be evaluated for including as part of combination HIV-prevention programs.
To read the full research article, go here.