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Review
. 2012 Feb;25(1):51-7.
doi: 10.1097/QCO.0b013e32834ef5ef.

Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence

Connie Celum  1 , Jared M Baeten
Affiliations
Review

Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence

Connie Celum et al. Curr Opin Infect Dis. 2012 Feb.

Abstract

Purpose of review: Topical tenofovir gel and oral tenofovir and emtricitabine-tenofovir [FTC/tenofovir disoproxyl fumarate (TDF)] have been demonstrated to have efficacy in preventing HIV-1 in some populations. Preexposure prophylaxis (PrEP) trials and future directions are summarized.

Recent findings: Pericoital use of 1% tenofovir gel in the CAPRISA 004 study reduced HIV-1 acquisition by 39% and herpes simplex virus-2 acquisition by 51%. Daily oral FTC/TDF demonstrated 44% reduction in HIV-1 acquisition among MSM in the iPrEx study (Pre-Exposure Prophylaxis Initiative). Both studies showed higher efficacy among those with higher adherence. Efficacy of daily oral TDF and FTC/TDF was 66 and 73%, respectively, among HIV-1-uninfected partners in an HIV-1 serodiscordant partnership in the Partners PrEP Study. Efficacy of daily oral FTC/TDF was 66% in young heterosexuals in Botswana in the TDF2 trial. The FEM-PrEP and VOICE (Vaginal and Oral Interventions to Control the Epidemic) studies in African women found no efficacy with oral FTC/TDF and TDF, respectively. Safety and tolerability were excellent and limited resistance was observed in seroconverters.

Summary: Topical tenofovir gel showed efficacy in African women and daily oral TDF and FTC/TDF were efficacious in MSM, and African HIV-1 serodiscordant couples and young heterosexuals. The reasons for lack of efficacy of oral FTC/TDF and TDF in two studies in African women are being investigated. Longer-acting formulations, invtravaginal rings, and new candidate antiretrovirals are being evaluated for pre-exposure prophylaxis (PrEP).

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1. Topical and oral PrEP: HIV prevention efficacy from completed clinical trials
Figure does not include oral tenofovir data from VOICE, as data have not been released Reproduced with permission from: Karim SSA and Karim QA; Antiretroviral prophylaxis: a defining moment in HIV control; The Lancet, Early Online Publication, 18 July 2011. doi:10.1016/S0140-6736(11)61136-7
See this image and copyright information in PMC

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