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2.2 million adults were newly HIV-infected in 2011, underscoring the urgent need for new, effective ways to prevent incident infections. Recently, the field of HIV prevention has gathered positive results from different strategies, among different populations, and with varying effect sizes, including the treatment of HIV-positive women and men in discordant couples, male circumcision of HIV-negative men in sub-Saharan Africa, a HIV vaccine evaluated in a community-based trial among HIV-negative men and women in Thailand, the use of vaginal gel formulation of TDF for HIV prevention in women in South Africa, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) or emtricitabine and TDF (TDF-FTC) among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda, and PrEP with TDF-FTC among heterosexual men and women in Africa. Of these interventions, PrEP is an attractive policy because it does not directly interferes with the sexual intercourse, providing people a choice on HIV prevention regardless of cultural, religious, or social harnesses. The use of PrEP is particularly interesting in high-risk populations that have been difficult to reach with traditional prevention strategies. For example, Grant et al. have published results from the Preexposure Prophylaxis Initiative (Iniciativa Preexposición - iPrEx) study, showing the efficacy of PrEP with a daily pill of TDF-FTC among HIV-seronegative men and transgender women who have sex with men. This randomized, multinational, placebo-controlled, double-blind trial included 2499 participants in clinical sites at North and South America, South Africa, and Thailand. Of the 100 incident HIV infections, 64 occurred among the group receiving placebo, and 36 among the group receiving FTC–TDF, resulting in an estimated efficacy of 44% (95% confidence interval: 15 to 63%). The protection reached 73% in those reporting at least 90% adherence to the pill use and, in recent follow-up results, up to 99% in those with detectable drug levels in the blood in once-a-day pill regime.

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2013-03-25   |   522 visitas   |   Evalua este artículo 0 valoraciones

Vol. 44 Núm.1. Enero-Marzo 2013 Pags. 68-69 Colomb Med 2013; 44(1)