Clinical trials of oral preexposure prophylaxis (PrEP) have focused on regimens of tenofovir (TDF) with or without emtricitabine (FTC). However, TDF may be associated with toxicities (renal, bone), and FTC may select for drug resistance. Both are also first-line drugs for HIV treatment. In this review, we discuss agents that might serve as alternatives to TDF/FTC for HIV PrEP.
Several drug characteristics are important to consider when selecting agents for PrEP with the most critical being safety, tolerability, adequate penetration into target tissues for prevention of HIV infection, and long-lasting activity with convenient dosing. With these factors in mind, we review five potentially useful agents for PrEP. The first group includes drugs that are already Food and Drug Administration approved (maraviroc, raltegravir) with attributes that make them attractive for PrEP. The second group includes investigational agents with long-lasting activity that are being developed in parenteral form (rilpivirine-long acting, S/GSK1265744, ibalizumab).
Future PrEP drugs may give clinicians the flexibility to select agents on the basis of individual patient needs and preferences.
Division of Infectious Diseases, Weill Cornell Medical Center, New York City, USA
Correspondence to Roy Gulick, MD, MPH, Division of Infectious Diseases, Box # 125, Weill Cornell Medical Center, 1300 York Avenue, New York, NY 10065, USA. Tel: +1 212 746 6320; e-mail: firstname.lastname@example.org