Skip Navigation LinksHome > August 24, 2013 - Volume 27 - Issue 13 > Efficacy of preexposure prophylaxis for HIV-1 prevention amo...
AIDS:
doi: 10.1097/QAD.0b013e3283629037
Epidemiology and Social: CONCISE COMMUNICATION

Efficacy of preexposure prophylaxis for HIV-1 prevention among high-risk heterosexuals: subgroup analyses from a randomized trial

Murnane, Pamela M.a,b; Celum, Conniea,b,c; Mugo, Nellyb,d,e; Campbell, James D.f,g; Donnell, Deborahb,h; Bukusi, Elizabethb,d,e; Mujugira, Andrewb; Tappero, Jordani; Kahle, Erin M.a,b; Thomas, Katherine K.b; Baeten, Jared M.a,b,c

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Abstract

Background:

Daily oral antiretroviral preexposure prophylaxis (PrEP) is a promising strategy for prevention of HIV-1 acquisition. Three clinical trials demonstrated PrEP efficacy; however, two PrEP trials among women did not find protection against HIV-1. One hypothesis proposed for these divergent results is that PrEP efficacy may be reduced in populations with higher HIV-1 incidence.

Methods:

Using data from the Partners PrEP Study, a randomized, placebo-controlled trial of daily oral tenofovir (TDF) and emtricitabine/tenofovir (FTC/TDF) PrEP among heterosexual HIV-1 serodiscordant couples from Kenya and Uganda, we assessed PrEP efficacy among subgroups at higher risk for HIV-1 acquisition, including subgroups of women with high HIV-1 incidence.

Results:

The overall placebo arm HIV-1 incidence was 2.0 per 100 person-years. Among higher risk subgroups, placebo arm HIV-1 incidence ranged from 3.9 to 6.6 per 100 person-years. In all subgroups, PrEP was protective against HIV-1 acquisition, with efficacy point estimates ranging from 64 to 84%. Among subgroups of women with placebo-arm HIV-1 incidence more than 5.0, efficacy estimates ranged from 64 to 84%. Monthly visit attendance for PrEP refills and tenofovir detection in plasma were high.

Conclusion:

Among higher-risk subgroups in the Partners PrEP Study, including groups solely of higher-risk women, both TDF alone and combined FTC/TDF PrEP had consistently high efficacy for HIV-1 protection. PrEP, when used with high adherence, is a highly effective prevention strategy for higher risk heterosexuals. Prioritizing PrEP for persons at high risk of HIV-1 will maximize its prevention impact.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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