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Pre-exposure prophylaxis against HIV infection

Authors
Kenneth H Mayer, MD
Douglas Krakower, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Up to two million new HIV infections occur yearly worldwide. As there is no effective vaccine to prevent HIV transmission, behavioral and biomedical HIV prevention strategies are needed to reduce HIV acquisition [1,2]. For HIV-uninfected patients, pre-exposure prophylaxis (PrEP) using antiretroviral medications is an evidence-based way to prevent new infections among those at greatest risk.

This topic will review how to identify and treat appropriate candidates for PrEP. A discussion of other strategies to prevent HIV infection, including the use of antiretroviral therapy for HIV-infected patients, post-exposure prophylaxis for HIV-uninfected patients, and male circumcision are discussed elsewhere. (See "HIV infection: Risk factors and prevention strategies" and "Management of nonoccupational exposures to HIV and hepatitis B and C in adults" and "Prevention of sexually transmitted infections", section on 'Male circumcision' and "Management of healthcare personnel exposed to HIV".)

APPROACH TO HIV PRE-EXPOSURE PROPHYLAXIS

For HIV-uninfected patients who are at high risk for acquiring HIV, and are committed to medication adherence, pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate–emtricitabine (TDF-FTC) can reduce the risk of HIV transmission by more than 90 percent [3]. However, the efficacy of this strategy requires patients' ongoing commitment to adherence. (See 'Efficacy' below and 'Medication adherence' below.)

To determine who should receive PrEP, clinicians should assess the potential benefits and risks of therapy:

Clinicians should obtain a detailed sexual and drug use history to determine if the patient is at high risk of HIV acquisition, and therefore, likely to benefit from PrEP. (See 'Assessing risk of HIV acquisition' below and 'Candidates for pre-exposure prophylaxis' below.)

                               

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Literature review current through: Nov 2016. | This topic last updated: Mon Apr 11 00:00:00 GMT+00:00 2016.
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