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Considerations regarding antiretroviral chemoprophylaxis and heterosexuals in generalized epidemic settings

Paxton, Lynn A.

doi: 10.1097/COH.0b013e328359064a
PRE-EXPOSURE PROPHYLAXIS: Edited by Kenneth H Mayer

Purpose of review: To discuss the factors pertinent to the use of pre-exposure prophylaxis (PrEP) by at-risk heterosexuals in countries with generalized HIV epidemics.

Recent findings: PrEP will have the greatest prevention effect if targeted to those at highest risk, but identifying and engaging such persons is challenging. Serodiscordant couples account for a high proportion of new infections and are an appropriate target for PrEP, but the proportion of people in such relationships is small and outside partnerships are common. Differences in adherence coupled to pharmacology of the drugs may account for differences in efficacy seen in the trials. Mathematical modeling indicates that the benefits of PrEP in highly endemic settings outweigh the risk of induced viral resistance. Behavioral risk compensation was not observed in the trials, but current open-label studies will better determine if disinhibition will be an important problem.

Conclusions: PrEP is a potentially useful HIV-prevention strategy for generalized heterosexual epidemics. Optimal implementation will require learning more about ways to improve acceptability and adherence and how best to deliver PrEP within the context of limited resource availability.

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Georgia, USA

Correspondence to Lynn A. Paxton, MD, MPH, 1600 Clifton Road, Mailstop A06, Atlanta, GA 30333, USA. Tel: +1 404 718 4706; e-mail: lap5@cdc.gov

© 2012 Lippincott Williams & Wilkins, Inc.