Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Aug;16(4):349-358.
doi: 10.1007/s11904-019-00450-9.

Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals

Matthew R Beymer  1 , Ian W Holloway  2 , Craig Pulsipher  3 , Raphael J Landovitz  4   5
Affiliations
Review

Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals

Matthew R Beymer et al. Curr HIV/AIDS Rep. 2019 Aug.

Abstract

Purpose of review: Pre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation.

Recent findings: Injectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use. On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.

Keywords: HIV/AIDS; Injectables; Microbicide gels; On-demand; Pre-exposure prophylaxis (PrEP); Vaginal rings.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

MRB, IWH, and CP declare that they have no conflict of interest.

References

    1. Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV et al. Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men. Science Translational Medicine 2012;4(151). doi:10.1126/scitranslmed.3004006. - DOI - PMC - PubMed
    1. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. N Engl J Med 2012;367(5):399–410. doi:10.1056/NEJMoa1108524. - DOI - PMC - PubMed
    1. United States Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States 2014. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf Accessed January 26, 2017 2017.

    1. Hosek SG, Landovitz RJ, Kapogiannis B, Siberry GK, Rudy B, Rutledge B et al. Safety and Feasibility of Antiretroviral Preexposure Prophylaxis for Adolescent Men Who Have Sex With Men Aged 15 to 17 Years in the United States. JAMA Pediatr 2017;171(11):1063–71. doi:10.1001/jamapediatrics.2017.2007.

      • This study was responsible for expanding the TDF/FTC PrEP indication down to include youth (weight of 35 kg or more) by the U.S. Food and Drug Administration.

    1. AIDS Vaccine Advocacy Coalition (AVAC). Regulatory status of Truvada for PrEP 2019.

Publication types