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HIV Preexposure ProphylaxisA Review

Educational Objective
To review the efficacy and safety of preexposure prophylaxis (PrEP) to prevent HIV transmission.
1 Credit CME

Importance  About 40 000 Americans and 2 million people worldwide are newly infected with HIV each year. The combination antiretroviral regimen, tenofovir disoproxil fumarate (TDF)/emtricitabine, taken as a single pill once daily, has been shown to prevent HIV transmission but is used by fewer than 20% of people who could benefit in the United States.

Observations  PubMed was searched on February 15, 2018, using the search terms pre-exposure, prophylaxis, HIV, and PrEP to identify English-language articles published between 2010 and 2018. Four placebo-controlled randomized clinical trials have demonstrated that preexposure prophylaxis (PrEP) with daily dosing of TDF/emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment. The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence. TDF/emtricitabine is safe and well-tolerated. Only 2% of people discontinue PrEP because of adverse effects. Sexually transmitted infections are common among those using PrEP. Resistance to TDF/emtricitabine when used for PrEP is rare (<0.1%) and usually occurs when PrEP is inadvertently prescribed to individuals with undiagnosed acute HIV infection who have false-negative findings on HIV antibody/antigen testing due to HIV infection acquired within 7 to 10 days of testing. Effective methods are needed to identify individuals at high risk for acquiring HIV, ensure their access to PrEP, and maximize medication adherence.

Conclusions and Relevance  TDF/emtricitabine is an effective and safe therapy for preventing HIV transmission. Increasing prescription of TDF/emtricitabine for patients at risk of acquiring HIV has the potential to reduce new HIV infections.

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Article Information

Corresponding Author: James Riddell IV, MD, University of Michigan Medical Center, 1500 E Medical Center Dr, University Hospital South F4131, Ann Arbor, MI 48109-5378 (jriddell@umich.edu).

Accepted for Publication: February 19, 2018.

Author Contributions: Dr Riddell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Amico, Mayer.

Acquisition, analysis, or interpretation of data: Riddell, Mayer.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Mayer.

Supervision: Riddell.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Riddell reported receiving grant support from GlaxoSmithKline and ViiV Healthcare. Dr Amico reported receiving an educational grant through the University of Michigan from Gilead Sciences for material development for PrEP awareness and serving as an expert in an advisory meeting in May 2017 for Gilead Sciences. Dr Mayer reported receiving unrestricted research grants from Gilead Sciences and ViiV Healthcare.

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