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July 20, 2011

PrEP: Adherence Matters

PrEP: Adherence Matters

Last November, the iPrEx study reported that, overall, the daily FTC/TDF (Truvada) used as pre-exposure HIV prophylaxis (PrEP) among 2,499 sexually active, non-HIV-infected men who have sex with men (MSM), and male-to-female transgender individuals who have sex with men, reduced HIV infection risk by 43.8 percent compared to placebo (36 HIV infections/1,251 on PrEP vs. 64 infections/1,248 on placebo).

And now, further analysis discussed by Dr. Robert Grant and colleagues in a late-breaker session at the IAS Conference in Rome, shows that in the subset of participants with the highest concentrations of FTC/TDF in their blood, the risk of HIV infection was 92% lower compared with placebo.Blood levels of FTC/TDF are tied to adherence as well as how well the drug is absorbed. Among seroconverters, lack of drug resistance or viral suppression indicated low PrEP exposure, the study authors reported.

“PrEP is an important HIV prevention tool with the potential to prevent significant numbers of new HIV infections,” said Grant. “These data confirm that PrEP is safe and effective in MSM, one of the populations most affected by HIV worldwide.”

Reporter Comment:
The essence of this report has to do with “adherence” to treatment. For those of us who choose to prescribe PrEP to our patients, it is important to cite the evidence behind it. PrEP is safe and effective when taken daily as prescribed, under medical supervision. The evidence clearly demonstrates that the higher the blood levels of the drugs, as seen with adherence, the greater the benefit at preventing infection.

Reference: Grant R, et al. Completed observation of the randomized placebo-controlled phase of iPrEx: daily oral FTC/TDF pre-exposure HIV prophylaxis among men and trans women who have sex with men [Oral Abstract]. Presented July 20, 2011, at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome, Italy. Abstract WELBC04.

Source: Reporting for PRN News from Rome, Italy: Bill Valenti, MD