Monica Gandhi, an infectious diseases specialist and professor at UCSF, dives into the world of preexposure prophylaxis (PrEP) for HIV. She discusses the alarming rate of new HIV infections globally and the innovative therapies available, including oral medications and the dapivirine ring, which empowers women in HIV prevention. Gandhi emphasizes the critical role of adherence in maximizing PrEP's effectiveness and shares strategies to improve it. She also advocates for primary care doctors to more widely prescribe PrEP, likening it to the adoption of contraception in healthcare.
Effective preexposure prophylaxis (PrEP) options, including oral and injectable forms, are crucial in reducing global HIV infections.
Improving adherence to PrEP through innovative strategies and increased healthcare provider prescriptions is vital for its overall success.
Deep dives
Understanding PrEP and Its Importance
PrEP, or pre-exposure prophylaxis, is essential for preventing HIV infections, with about 1.3 million new cases reported globally each year. It is recommended for individuals at high risk of HIV, including those with a history of sexually transmitted infections and injection drug users. The availability of effective medications means that PrEP should be a critical component of public health strategies, but many remain unaware of their eligibility for this prevention method. Reaching those at risk is key to significantly reducing the number of new infections worldwide.
Variety and Effectiveness of PrEP Therapies
Currently, there are both oral and injectable forms of PrEP, with daily oral TDF-FTC as the most common regimen, showing up to 96% effectiveness with proper adherence. Injectable options, such as cabotegravir, have shown superior efficacy and are administered every eight weeks, but accessibility remains a concern. Newer agents, like lenacapivir and the dapivirine ring, offer additional choices, especially for women, yet their adoption and approval vary by region. The emphasis on providing various options aims to increase usage rates and adaptability for different populations.
Enhancing Adherence to PrEP
Adherence to PrEP is critical for its success, with studies indicating that at least four doses per week are necessary for optimal effectiveness. Various strategies can help improve adherence, including counseling, adherence clubs, and innovative methods like urine tenofovir assays that validate medication intake. Additionally, on-demand PrEP provides a flexible alternative for individuals who can predict their potential exposure to HIV, although it has mainly been studied within specific demographics. Increased prescription by healthcare providers, including generalists and urgent care professionals, is essential for making PrEP more widely available and utilized.
Even though highly effective medications are currently available to prevent HIV, there are about 1.3 million new infections worldwide each year. Monica Gandhi, MD, MPH, of the University of California San Francisco joins JAMA Senior Editor Karen E. Lasser, MD, MPH, to discuss preexposure prophylaxis (PrEP) for HIV. Related Content: