What is the place of pre-exposure prophylaxis in HIV prevention?

Jeroen De Man, R. Colebunders, E. Florence, M. Laga, C. Kenyon

Research output: Contribution to journalA1: Web of Science-article

Abstract

New tools are needed to bring down ongoing high HIV incidence. This review aims to evaluate the place of one of these new tools (pre-exposure prophylaxis) in a comprehensive prevention strategy. Several trials have demonstrated the safety and the efficacy of pre-exposure prophylaxis in HIV prevention. Two large trials have, however, failed to show such efficacy. This was likely due to poor adherence in these trials. New forms of long-acting pre-exposure prophylaxis currently in trials may deal with these problems of low adherence. Pre-exposure prophylaxis has been demonstrated to be cost-effective within certain settings. The introduction of pre-exposure prophylaxis into prevention programs needs to be carefully thought through. For example, pre-exposure prophylaxis-induced risk compensation, at both an individual and population level, could undermine other aspects of a comprehensive HIV prevention program. In conclusion, pre-exposure prophylaxis could be a useful additional tool for the prevention of HIV in specific high-risk groups. It should be implemented in a way that deals with issues such as ensuring high adherence and ensuring that pre-exposure prophylaxis does not detract from, but complements, other more fundamental elements of HIV prevention programs.
Original languageEnglish
JournalAIDS Reviews
Volume15
Issue number2
Pages (from-to)102-111
Number of pages10
ISSN1139-6121
Publication statusPublished - 2013

Keywords

  • Viral diseases
  • HIV
  • Prevention strategies
  • Pre-exposure
  • Prophylaxis
  • Evaluation
  • Safety
  • Efficacy
  • Compliance
  • Cost-effectiveness
  • Risk groups
  • Homosexuals
  • Discordance
  • Prostitutes
  • Recommendations
  • Clinical trials
  • Adverse effects
  • Drug resistance
  • Implementation
  • Review of the literature

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