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Systemic preexposure prophylaxis for HIV: translating clinical data to clinical practice.
Ann Pharmacother. 2014 Apr; 48(4):507-18.AP

Abstract

OBJECTIVE

To assess the real-world implications of oral tenofovir-emtricitabine (TDF-FTC) for HIV preexposure prophylaxis (PrEP) in clinical practice and highlight important considerations for its implementation.

DATA SOURCES

A search of PubMed (January 1996 through June 2013) was conducted using the terms HIV preexposure prophylaxis, HIV prevention, tenofovir, and emtricitabine. Abstracts from 2012-2013 HIV/AIDS conferences were also reviewed.

STUDY SELECTION AND DATA EXTRACTION

All pertinent original studies and review articles published in English were evaluated for inclusion. Reference citations from identified articles were examined for additional content.

DATA SYNTHESIS

Although antiretroviral therapy has been highly successful in reducing AIDS outcomes and death in HIV-infected patients worldwide, transmission of HIV remains a major global health problem. The recent approval of oral TDF-FTC for HIV PrEP represents the latest biomedical intervention to help control this epidemic. Four published randomized studies evaluated the efficacy and safety of this combination to prevent HIV transmission in several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexuals residing in endemic regions. Overall, these studies demonstrated significant risk reductions in the incidence of new HIV infections with good short-term tolerability. Despite promising results from clinical studies, several limitations may hinder the utility of PrEP in clinical practice. Most importantly, PrEP was studied in the context of a comprehensive prevention program, including intensive counseling on adherence, high-risk behaviors, and traditional preventative measures. If PrEP is implemented without these adjunct measures, concerns about failure and increased resistance may eventually be realized.

CONCLUSION

The greatest impact of PrEP, both clinically and financially, will likely arise from judicious application in select high-risk populations. If used appropriately, PrEP has the potential to augment reductions in the current incidence of new HIV infections, and pharmacists will have an important role in the careful selection and counseling of these targeted populations.

Authors+Show Affiliations

South Texas Veterans Health Care System, San Antonio, TX, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24473492

Citation

Li, Julius, et al. "Systemic Preexposure Prophylaxis for HIV: Translating Clinical Data to Clinical Practice." The Annals of Pharmacotherapy, vol. 48, no. 4, 2014, pp. 507-18.
Li J, Dufrene SL, Okulicz JF. Systemic preexposure prophylaxis for HIV: translating clinical data to clinical practice. Ann Pharmacother. 2014;48(4):507-18.
Li, J., Dufrene, S. L., & Okulicz, J. F. (2014). Systemic preexposure prophylaxis for HIV: translating clinical data to clinical practice. The Annals of Pharmacotherapy, 48(4), 507-18. https://doi.org/10.1177/1060028014520880
Li J, Dufrene SL, Okulicz JF. Systemic Preexposure Prophylaxis for HIV: Translating Clinical Data to Clinical Practice. Ann Pharmacother. 2014;48(4):507-18. PubMed PMID: 24473492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic preexposure prophylaxis for HIV: translating clinical data to clinical practice. AU - Li,Julius, AU - Dufrene,Staci L, AU - Okulicz,Jason F, Y1 - 2014/01/28/ PY - 2014/1/30/entrez PY - 2014/1/30/pubmed PY - 2014/12/18/medline KW - HIV KW - emtricitabine KW - human immunodeficiency virus KW - preexposure prophylaxis KW - prevention KW - tenofovir SP - 507 EP - 18 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 48 IS - 4 N2 - OBJECTIVE: To assess the real-world implications of oral tenofovir-emtricitabine (TDF-FTC) for HIV preexposure prophylaxis (PrEP) in clinical practice and highlight important considerations for its implementation. DATA SOURCES: A search of PubMed (January 1996 through June 2013) was conducted using the terms HIV preexposure prophylaxis, HIV prevention, tenofovir, and emtricitabine. Abstracts from 2012-2013 HIV/AIDS conferences were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All pertinent original studies and review articles published in English were evaluated for inclusion. Reference citations from identified articles were examined for additional content. DATA SYNTHESIS: Although antiretroviral therapy has been highly successful in reducing AIDS outcomes and death in HIV-infected patients worldwide, transmission of HIV remains a major global health problem. The recent approval of oral TDF-FTC for HIV PrEP represents the latest biomedical intervention to help control this epidemic. Four published randomized studies evaluated the efficacy and safety of this combination to prevent HIV transmission in several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexuals residing in endemic regions. Overall, these studies demonstrated significant risk reductions in the incidence of new HIV infections with good short-term tolerability. Despite promising results from clinical studies, several limitations may hinder the utility of PrEP in clinical practice. Most importantly, PrEP was studied in the context of a comprehensive prevention program, including intensive counseling on adherence, high-risk behaviors, and traditional preventative measures. If PrEP is implemented without these adjunct measures, concerns about failure and increased resistance may eventually be realized. CONCLUSION: The greatest impact of PrEP, both clinically and financially, will likely arise from judicious application in select high-risk populations. If used appropriately, PrEP has the potential to augment reductions in the current incidence of new HIV infections, and pharmacists will have an important role in the careful selection and counseling of these targeted populations. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/24473492/Systemic_preexposure_prophylaxis_for_HIV:_translating_clinical_data_to_clinical_practice_ L2 - https://journals.sagepub.com/doi/10.1177/1060028014520880?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -