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Systemic preexposure prophylaxis for human immunodeficiency virus infection.
Pharmacotherapy. 2010 Oct; 30(10):1021-30.P

Abstract

Antiretroviral therapy has significantly improved the typical course of human immunodeficiency virus (HIV) infection in industrialized nations, and life expectancies associated with the infection have increased. However, infection rates have generally remained unchanged, with increases noted among certain subpopulations. The use of systemic preexposure prophylaxis for HIV infection has been proposed as an intervention to reduce the risk of disease transmission in at-risk individuals. The basis of this prophylaxis involves the orchestrated use of antiretrovirals in uninfected individuals either continuously or just before high-risk situations, such as perinatal and occupational exposure to HIV, in order to reduce the likelihood of successful HIV infection. Data from the use of antiretrovirals to prevent HIV infection in these scenarios support the concept of preexposure prophylaxis. Preliminary animal studies have focused on the use of antiretrovirals to prevent simian immunodeficiency virus infection in macaque monkeys, and these data have provided support for the potential efficacy of preexposure prophylaxis for HIV in humans. Limited human data are available, however, but studies are ongoing. Clinical trials have focused on the use of tenofovir disoproxil fumarate either alone or in combination with emtricitabine. Tenofovir-emtricitabine-based regimens may be ideal, given the drugs' pharmacodynamic and pharmacokinetic properties. Some investigators have surveyed at-risk individuals to assess their knowledge of preexposure prophylaxis and whether they used or intended to use this prevention strategy. Routine use of preexposure prophylaxis and even knowledge of its existence appear to be very limited. If efficacy is proved, use of preexposure prophylaxis faces several ethical issues. Ultimately, its success will depend on proof of cost-effectiveness. Until the many questions concerning optimal use of preexposure prophylaxis for HIV are answered, however, its use should be limited to research-related clinical investigations.

Authors+Show Affiliations

Colleges of Pharmacy, University of Kentucky, Lexington, Kentucky 40536, USA. froma2@uky.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20874040

Citation

Romanelli, Frank, and Brian Murphy. "Systemic Preexposure Prophylaxis for Human Immunodeficiency Virus Infection." Pharmacotherapy, vol. 30, no. 10, 2010, pp. 1021-30.
Romanelli F, Murphy B. Systemic preexposure prophylaxis for human immunodeficiency virus infection. Pharmacotherapy. 2010;30(10):1021-30.
Romanelli, F., & Murphy, B. (2010). Systemic preexposure prophylaxis for human immunodeficiency virus infection. Pharmacotherapy, 30(10), 1021-30. https://doi.org/10.1592/phco.30.10.1021
Romanelli F, Murphy B. Systemic Preexposure Prophylaxis for Human Immunodeficiency Virus Infection. Pharmacotherapy. 2010;30(10):1021-30. PubMed PMID: 20874040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic preexposure prophylaxis for human immunodeficiency virus infection. AU - Romanelli,Frank, AU - Murphy,Brian, PY - 2010/9/30/entrez PY - 2010/9/30/pubmed PY - 2011/4/7/medline SP - 1021 EP - 30 JF - Pharmacotherapy JO - Pharmacotherapy VL - 30 IS - 10 N2 - Antiretroviral therapy has significantly improved the typical course of human immunodeficiency virus (HIV) infection in industrialized nations, and life expectancies associated with the infection have increased. However, infection rates have generally remained unchanged, with increases noted among certain subpopulations. The use of systemic preexposure prophylaxis for HIV infection has been proposed as an intervention to reduce the risk of disease transmission in at-risk individuals. The basis of this prophylaxis involves the orchestrated use of antiretrovirals in uninfected individuals either continuously or just before high-risk situations, such as perinatal and occupational exposure to HIV, in order to reduce the likelihood of successful HIV infection. Data from the use of antiretrovirals to prevent HIV infection in these scenarios support the concept of preexposure prophylaxis. Preliminary animal studies have focused on the use of antiretrovirals to prevent simian immunodeficiency virus infection in macaque monkeys, and these data have provided support for the potential efficacy of preexposure prophylaxis for HIV in humans. Limited human data are available, however, but studies are ongoing. Clinical trials have focused on the use of tenofovir disoproxil fumarate either alone or in combination with emtricitabine. Tenofovir-emtricitabine-based regimens may be ideal, given the drugs' pharmacodynamic and pharmacokinetic properties. Some investigators have surveyed at-risk individuals to assess their knowledge of preexposure prophylaxis and whether they used or intended to use this prevention strategy. Routine use of preexposure prophylaxis and even knowledge of its existence appear to be very limited. If efficacy is proved, use of preexposure prophylaxis faces several ethical issues. Ultimately, its success will depend on proof of cost-effectiveness. Until the many questions concerning optimal use of preexposure prophylaxis for HIV are answered, however, its use should be limited to research-related clinical investigations. SN - 1875-9114 UR - https://www.unboundmedicine.com/medline/citation/20874040/Systemic_preexposure_prophylaxis_for_human_immunodeficiency_virus_infection_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=20874040.ui DB - PRIME DP - Unbound Medicine ER -