Prevention of human immunodeficiency virus (HIV) transmission by medication, otherwise known as preexposure prophylaxis (PrEP), is offered to people who wish to reduce their risk of becoming infected by this virus during the course of high-risk sexual practices, or needle sharing during drug use. In 2017, the initial evaluation of the emtricitabine + tenofovir combination (Truvada° and other brands) established it as a useful option in this setting.

In 2019, the US Preventive Services Task Force (USPTF), a public body in the United States which evaluates prevention strategies, published a review of clinical trials of PrEP. Twelve randomised trials, of which 11 were placebo-controlled, evaluated the efficacy of tenofovir, or the combination of emtricitabine + tenofovir, in a total of 18 244 adults, with follow-up varying from 4 months to 4 years. In the trials in which adherence was estimated as at least 70%, the risk of HIV infection was clearly reduced, with adverse effects which were, in general, acceptable. Notably, one of these conclusive trials was carried out in France, with the emtricitabine + tenofovir combination.

As of the beginning of 2021, in patients at high risk of HIV infection because of high-risk sexual practices, or sharing of equipment for drug injection, evaluation has confirmed the efficacy of PrEP. When this type of prevention is chosen, particular attention should be paid to adherence, whether the choice is continuous or intermittent treatment, and to monitoring of renal function.

For those who cannot further reduce their risk taking behaviour, regular screening for sexually-transmitted infections, including HIV, plus hepatitis B vaccination, are other preventative actions to be taken.

©Prescrire 1 June 2021

Source: "Pre-exposure prophylaxis for HIV (PrEP). Useful for some high-risk patients" Prescrire International 2021; 30 (227): 160-161. Subscribers only.

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