Effectiveness and safety of oral HIV preexposure prophylaxis for all populations

Datos Bibliográficos

ID23375528
AutoresVirginia A Fonner (0000-0002-9005-3549, Apple (Israel), autor de correspondencia), Sarah L Dalglish (0000-0002-7218-5193, Apple (Israel)), Caitlin E Kennedy (0000-0001-6820-063X, Apple (Israel)), Rachel Baggaley (0000-0001-6320-3444, Apple (Israel)), Kevin O’reilly (0000-0002-9982-4944, Apple (Israel)), Kevin R O’Reilly, Florence Koechlin (Apple (Israel)), Florence M Koechlin, Michelle Rodolph (Apple (Israel)), Ioannis Hodges-Mameletzis (0000-0002-7245-8198, Apple (Israel)), Robert M Grant (0000-0002-0851-7085, Apple (Israel))
Año2016
Volumen30
Número12
Páginas1973-1983
Fecha de publicación2016-07-31
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaAIDS (JOURNAL)
Identificadores de la revistaISSN: 0269-9370 • E-ISSN: 1473-5571
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qad.0000000000001145
PMID27149090
OpenAlexW2345950548
IdiomaEN
Citas recibidas194
Referencias citadas45

OBJECTIVE: Preexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes. DESIGN: Rigorous systematic review and meta-analysis. METHODS: A comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis. RESULTS: Eighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness. CONCLUSION: PrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk.

Adverse effect · Alternative medicine · Confidence interval · Human immunodeficiency virus (HIV) · Men who have sex with men · Meta-analysis · Placebo · Pre-exposure prophylaxis · Relative risk · Risk compensation · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Immunology · Internal Medicine · Medicine · Reproductive tract infections research