A great concern in respect to the deployment of Pre-Exposure Prophylaxis (PrEP) as an HIV prevention tool is risk compensation – i.e. the possibility that the protection afforded by PrEP would itself encourage sexual risk-taking (STI blogs/Sugarman & Mayer). Recent studies of PrEP efficacy would seem an unpromising context in which to assess the likely impact […]
Category: pre-exposure prophylaxis
Partners PrEP sub-study finds no evidence that PrEP use is associated with risk compensation behaviour
How useful is pre-exposure prophylaxis (PrEP)? The Partners PrEP randomized control study of daily pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-discordant couples in Uganda and Kenya has indicated that, given adequate adherence, PrEP has high biologic efficacy. The study itself (Baeten & Celum) demonstrates levels of risk reduction of 75%; while a spin-off sub-study […]
RCT trial demonstrates: disappointing PrEP study outcomes probably down to poor adherence
The disappointingly varied results of recent clinical trials of antiretroviral prophylaxis for HIV prevention (PrEP) have not altogether dampened the interest in this intervention. Contributions to STI journal include papers evaluating the potential acceptability of PrEP in various settings (see: Aghaizu & Nardone; Holt & De Wit). Clearly, there remains a keen interest in the […]
The ethics of PrEP
A recent article in the US journal JAIDS, Sugarman & Mayer (S&M), provides a handy outline of the ethical issues around pre-exposure prophylaxis (PrEP) for HIV infection (Sugarman & Mayer). The subject is very topical in the US, now that the Food and Drinks Administration have taken a step ahead of the rest of the […]
Disappointing tenofovir PrEP trials: maybe “adherence” is not to blame
Reports of modest success from two trials (2010) of tenofovir as pre-exposure prophylaxis against HIV (PrEP)– CAPRISA 004 (1) (topical gel/women) relative risk reduction (RRR) 39%; iPrEX (2) (oral tablet/MSM) RRR 44% – have inspired recent contributions to STI journal. In particular, there have been attempts to model the possible impact on the epidemic of […]
Can HIV PrEP for MSM be a cost-effective intervention?
In the wake of the 2010 results of the Pre-Exposure Prophylaxis Initiative (iPrEx) study – a multi-national trial of daily oral tenofovir/emtricitabine to prevent acquisition of HIV among men who have sex with men (MSM) indicating a 44% reduction in risk – there have been attempts to model the potential health impact and cost-effectiveness of […]
HIV and breastfeeding in Africa: balancing the risks
One area in which the recent wide scale deployment of ARV could have the greatest impact is that of mother-to-child HIV transmission (PMTCT). The UNAIDS goal is for total elimination of PMTCT by 2015 – though this is scarcely feasible (STI 2010:86 Suppl.II – especially M. Mahy et al. (http://sti.bmj.com/content/86/Suppl_2/ii48.full?sid=50f44956-1266-4dd0-bed1-08ebd39bb60a)). A component of the PMTCT […]
PrEP no panacea
One potential approach to HIV prevention attracting much current interest is the use of “pre-exposure prophylaxis” (PrEP). This involves taking anti-retroviral drugs (ARV) before exposure to HIV in order to reduce the risk of transmission. In parallel with clinical trials currently underway to establish the efficacy of PrEP, an important body of research is investigating […]