Tags

Type your tag names separated by a space and hit enter

Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals.

Abstract

BACKGROUND

Twenty-five years into the global HIV/AIDS epidemic, infection rates remain alarmingly high, with over 4 million people becoming infected every year. There is a need for HIV prevention strategies that are more effective. Oral antiretroviral pre-exposure prophylaxis (PrEP) in high-risk individuals may be a reliable tool in preventing the transmission of HIV.

OBJECTIVES

To evaluate the risk reduction and side effects of antiretroviral chemoprophylaxis in preventing HIV infection in high-risk individuals

SEARCH STRATEGY

We conducted electronic searches of MEDLINE (1980 through June 2008); the Cochrane Central Register of Controlled Trials (March 2008); EMBASE (June 2008); and AIDSearch (June 2008). We also searched the WHO International Clinical Trials Registry Platform in June 2008 for ongoing or prospective trials.

SELECTION CRITERIA

Randomized controlled trials that evaluated the effects of any antiretroviral agent in preventing HIV infection in high-risk individuals

DATA COLLECTION AND ANALYSIS

Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. The information gathered from each included trial were location of the trial, date, publication status, demographics of participants (e.g. age, gender, risk behaviour), exposure modality, type of antiretroviral drug used, duration of drug use, and outcomes. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. Only one trial met our inclusion criteria, so we did not perform a meta-analysis.

MAIN RESULTS

One randomised controlled trial met the criteria for the review, although it was not completed as planned. The trial did not have the statistical power to answer questions about the efficacy of antiretroviral PrEP for HIV prevention in the assessed risk group.

AUTHORS' CONCLUSIONS

Presently there is no reliable evidence to support the use of any antiretroviral agent for HIV chemoprophylaxis.The value of chemoprophylaxis for HIV prevention cannot be assessed on the basis of the included trial. The result was not statistically significant and, moreover, the trial was not completed as planned; therefore, the use of antiretroviral agents for HIV chemoprophylaxis cannot be recommended at present. To assess the value of antiretroviral agents for HIV chemoprophylaxis, we advocate well-conducted trials with the statistical power to answer questions about PrEP efficacy and safety in various populations and risk groups. These trials also should evaluate other important issues of concern, such as drug safety, adherence, drug resistance, and the effect of PrEP on risk behaviour.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Lagos University Teaching hospital, Idiaraba, Lagos, Nigeria, PMB 12003. okwundu2006@yahoo.comNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

19160329

Citation

Okwundu, Charles I., and Christy A N. Okoromah. "Antiretroviral Pre-exposure Prophylaxis (PrEP) for Preventing HIV in High-risk Individuals." The Cochrane Database of Systematic Reviews, 2009, p. CD007189.
Okwundu CI, Okoromah CA. Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. Cochrane Database Syst Rev. 2009.
Okwundu, C. I., & Okoromah, C. A. (2009). Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. The Cochrane Database of Systematic Reviews, (1), CD007189. https://doi.org/10.1002/14651858.CD007189.pub2
Okwundu CI, Okoromah CA. Antiretroviral Pre-exposure Prophylaxis (PrEP) for Preventing HIV in High-risk Individuals. Cochrane Database Syst Rev. 2009 Jan 21;(1)CD007189. PubMed PMID: 19160329.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. AU - Okwundu,Charles I, AU - Okoromah,Christy A N, Y1 - 2009/01/21/ PY - 2009/1/23/entrez PY - 2009/1/23/pubmed PY - 2009/3/20/medline SP - CD007189 EP - CD007189 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Twenty-five years into the global HIV/AIDS epidemic, infection rates remain alarmingly high, with over 4 million people becoming infected every year. There is a need for HIV prevention strategies that are more effective. Oral antiretroviral pre-exposure prophylaxis (PrEP) in high-risk individuals may be a reliable tool in preventing the transmission of HIV. OBJECTIVES: To evaluate the risk reduction and side effects of antiretroviral chemoprophylaxis in preventing HIV infection in high-risk individuals SEARCH STRATEGY: We conducted electronic searches of MEDLINE (1980 through June 2008); the Cochrane Central Register of Controlled Trials (March 2008); EMBASE (June 2008); and AIDSearch (June 2008). We also searched the WHO International Clinical Trials Registry Platform in June 2008 for ongoing or prospective trials. SELECTION CRITERIA: Randomized controlled trials that evaluated the effects of any antiretroviral agent in preventing HIV infection in high-risk individuals DATA COLLECTION AND ANALYSIS: Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. The information gathered from each included trial were location of the trial, date, publication status, demographics of participants (e.g. age, gender, risk behaviour), exposure modality, type of antiretroviral drug used, duration of drug use, and outcomes. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. Only one trial met our inclusion criteria, so we did not perform a meta-analysis. MAIN RESULTS: One randomised controlled trial met the criteria for the review, although it was not completed as planned. The trial did not have the statistical power to answer questions about the efficacy of antiretroviral PrEP for HIV prevention in the assessed risk group. AUTHORS' CONCLUSIONS: Presently there is no reliable evidence to support the use of any antiretroviral agent for HIV chemoprophylaxis.The value of chemoprophylaxis for HIV prevention cannot be assessed on the basis of the included trial. The result was not statistically significant and, moreover, the trial was not completed as planned; therefore, the use of antiretroviral agents for HIV chemoprophylaxis cannot be recommended at present. To assess the value of antiretroviral agents for HIV chemoprophylaxis, we advocate well-conducted trials with the statistical power to answer questions about PrEP efficacy and safety in various populations and risk groups. These trials also should evaluate other important issues of concern, such as drug safety, adherence, drug resistance, and the effect of PrEP on risk behaviour. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19160329/Antiretroviral_pre_exposure_prophylaxis__PrEP__for_preventing_HIV_in_high_risk_individuals_ L2 - https://doi.org/10.1002/14651858.CD007189.pub2 DB - PRIME DP - Unbound Medicine ER -