What are the benefits and challenges of delivering preexposure prophylaxis (PrEP) against HIV infection?

Updated: Oct 08, 2019
  • Author: Alejandro Delgado, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The idea of treatment as prevention for HIV-1 infection has gathered tremendous enthusiasm and is driven by a) failure of behavioral and biological prevention efforts; b) biological plausibility of the use of ARV for prevention; c) cheaper, safer, and simpler ART regimens; and d) recent clinical trials that show promise for the intervention.

PrEP has the potential to contribute to effective and safe HIV prevention when 1) it is targeted to individuals at high risk for HIV acquisition; 2) delivered as part of a comprehensive set of prevention services, including risk-reduction and PrEP medication adherence counseling, ready access to condoms, and diagnosis and treatment of sexually transmitted infections; 3) and it is accompanied by monitoring of HIV status, side effects, adherence, and risk behaviors at regular intervals.

The FDA approval of emtricitabine/tenofovir (Truvada) for PrEP now offers options to high-risk groups including men who have sex with men and serodiscordant couples. Additionally, current CDC guidelines include additional populations (eg, IV drug users, heterosexual individuals at high risk).

In spite of the promise and the progress of PrEP, concerns about durability of protection, the balance of benefits and adverse events associated with earlier therapy, and long-term adherence and transmission of ART-resistant strains to partners remain. Longer-term studies are needed but should not preclude the implementation of this strategy. As the search for an effective vaccine continues, interventions like PrEP could significantly slow the HIV epidemic.


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