Preexposure Prophylaxis for the Prevention of HIV Infection

Abstract

IMPORTANCE Effective prevention strategies for HIV infection are an important public health priority. Preexposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) daily or before and after sex to decrease risk of acquiring HIV infection. OBJECTIVE To synthesize the evidence on the benefits and harms of PrEP, instruments for predicting incident HIV infection, and PrEP adherence to inform the US Preventive Services Task Force.

Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014–2018

“…the proportion of ineligible participants among those who did not seroconvert). We also computed the number needed to treat (NNT) to prevent one HIV infection among eligible individuals under three scenarios: (i) a relative reduction of 97% as reported in the open-label extension of the ANRS IPERGAY study [24], (ii) a relative reduction of 86% as in the ANRS IPERGAY trial and PROUD study [12,13] and (iii) a relative reduction of 77% as in a meta-analysis of randomised clinical trials among MSM [10]. We used this relative reduction to calculate the expected IR had PrEP been given to eligible individuals.…”

“…Operational definition of eligibility a WHO criteria (2017) [20] 1. Vaginal or anal sexual intercourse without a condom with more than one partner, or MSM was estimated at 77% but highly correlated with adherence [10]. Clinical guidelines were designed to help healthcare professionals in the provision of PrEP by defining the eligibility criteria to identify those at higher risk of infection.…”

“…ANRS IPERGAY (open-label extension) [25] PROUD study [13] and ANRS IPERGAY trial [12] Meta-analysis of RCTs among MSM [10] Relative reduction 97% 86% 77% variables collected in questionnaires of the cohort are not exactly phrased as the criteria and (ii) our analysis was grounded in behavioural risk and not in clinical eligibility, with the exception of the HIV antibody determination; therefore, there was no clinical information to assess any contraindication for PrEP, which may overestimate the expected advantages. The timing of exposure ascertainment should also be discussed.…”

“…Several screening tools and guidelines exist that help healthcare providers identify high-risk individuals based on HIV predictors [6][7][8][9]. However, they were associated with moderate discrimination in predicting incident HIV infections [10].…”

<p>Current Perspectives on the Impact of Pre-Exposure Prophylaxis Stigma Regarding Men Who Have Sex with Men in the United States</p>

“…Based on a review of 14 randomized clinical trials, 8 observational studies, and 7 studies of diagnostic accuracy demonstrating that PrEP was associated with decreased risk of infection, the United States Preventative Services Task Force (USPSTF) issued a Grade A recommendation for HIV prevention and HIV screening in adults, adolescents, and pregnant women. 15 The USPSTF guidelines offer an important recognition of PrEP's efficacy and value as a prevention tool. Further, the USPSTF suggested health professionals should be mindful of the health disparities disproportionally affecting racial/ethnic minorities.…”