Pre-exposure prophylaxis, or PrEP, for HIV prevention
has garnered a lot of attention over the last several years,
beginning with the positive results from the iPrEx trial in
men who have sex with men (MSM) reported in late 2010.1
Since then, the field has seen both positive and flat results
from other trials, leading to a regulatory and normative
movement that is helping to chart the way for PrEP access
for those who can use it as an HIV prevention option.
In July 2012, the U.S. Food and Drug Administration
(FDA) approved the HIV treatment drug Truvada for use as
a once-a-day prevention option for HIV-negative men and
women. This was the first time an antiretroviral (ARV) treatment
drug had been approved to reduce the risk of HIV
infection via sexual exposure and the only FDA-approved
option via this mode of transmission since the approval of
the female condom in 1993. Around the time of the FDA
decision, the World Health Organization (WHO) issued
guidelines for countries planning PrEP demonstration projects.
These demonstration projects will look at how daily
PrEP might be used in different real-world settings, when
people know they are taking an intervention that works
as opposed to in a clinical trial when it’s not clear an intervention
works and a portion of participants get a placebo.
While these moves from regulatory and normative agencies
signal the significance of PrEP as an important HIV
prevention option, recent clinical trial data suggest that a
daily pill-taking approach for PrEP may not work for everyone
at risk. So how can Truvada as PrEP best be used?
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