Matthew R Beymer1, Ian W Holloway2, Craig Pulsipher3, Raphael J Landovitz4,5. 1. Department of Health and Mental Health Services, Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 114-E, Los Angeles, CA, 90028, USA. mrbeymer@gmail.com. 2. Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, 337 Charles E Young Drive East, Los Angeles, CA, 90095, USA. 3. APLA Health, 611 S Kingsley Dr, Los Angeles, CA, 90005, USA. 4. David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA. 5. UCLA Center for Clinical AIDS Research & Education (CARE), 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90024, USA.
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.
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.
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