Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals

Cochrane Database of Systematic Reviews, 2012

Publication History Publication Status: New search for studies and content updated (conclusions changed) Published Online: 11 JUL 2012 SEARCH ARTICLE TOOLS Abstract Abstract Background More than 30 years into the global HIV/AIDS epidemic, infection rates remain alarmingly high, with over 2.7 million people becoming infected every year.
Oral antiretroviral pre-exposure prophylaxis (PrEP) in high-risk individuals may be a reliable tool in preventing the transmission of HIV.
Objectives To evaluate the effects of oral antiretroviral chemoprophylaxis in preventing HIV infection in HIV-uninfected high-risk individuals.
Search methods We revised the search strategy from the previous version of the review and conducted an updated search of MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in April 2012.
We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing trials.
Selection criteria Randomised controlled trials that evaluated the effects of any antiretroviral agent or combination of antiretroviral agents in preventing HIV infection in high-risk individuals Data collection and analysis Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form.
Main results We identified 12 randomised controlled trials that meet the criteria for the review.
The trials evaluated the following: daily oral tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) versus placebo; TDF versus placebo and daily TDF-FTC versus intermittent TDF-FTC.
The studies were carried out amongst different risk groups, including HIV-uninfected men who have sex with men, serodiscordant couples and other high risk men and women.
Overall results from the four trials that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection (RR 0.51; 95% CI 0.30 to 0.86; 8918 participants).
Similarly, the overall results of the studies that compared TDF only versus placebo showed a significant reduction in the risk of acquiring HIV infection (RR 0.38; 95% CI 0.23 to 0.63, 4027 participants).