TITLE

Who's prepared to make PrEP work?

AUTHOR(S)
Mascolini, Mark
PUB. DATE
December 2012
SOURCE
Research Initiative/Treatment Action!;Winter2012, Vol. 17 Issue 2, p5
SOURCE TYPE
Periodical
DOC. TYPE
Article
ABSTRACT
Tenofovir/emtricitabine (TDF/FTC) won FDA approval for preexposure prophylaxis (PrEP) after three placebo-controlled trials demonstrated that once-daily TDF/FTC lowers HIV acquisition risk in gay and bisexual men and heterosexual women and men. In the one trial that found no HIV protection with TDF/FTC PrEP in women, poor adherence largely explained that failure. Good adherence in the three successful PrEP trials enhanced the protective potential of this two-in-one, once-daily antiretroviral. Emergence of HIV resistant to FTC and/or TDF in PrEP users is unlikely--provided that people do not start PrEP when infected with HIV and that they do not take few enough doses to become infected but just enough doses to maintain meager drug levels. Placebo-controlled PrEP trials in gay men and heterosexuals found that study participants practiced safer sex after being randomized. But community-based research in the United States indicates that a substantial proportion of PrEP candidates would abandon condoms if they took a fairly reliable PrEP pill. Three modeling studies suggest TDF/FTC PrEP may not be cost-effective at current TDF/FTC prices with only moderate efficacy. But lower costs and higher efficacy could make PrEP cost-effective by current standards. Researchers are already testing future PrEP agents, which fall into three (sometimes overlapping) groups-current or investigational antiretrovirals with mechanisms different from TDF and FTC, longer-acting antiretrovirals that may be taken by mouth or injection, and longer-acting antiretrovirals suffused into vaginal rings.
ACCESSION #
89368685

 

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