Colleges of Pharmacy, University of Kentucky, Lexington, Kentucky 40536, USA.
Pharmacotherapy. 2010 Oct;30(10):1021-30. doi: 10.1592/phco.30.10.1021.
Antiretroviral therapy has significantly improved the typical course of human immunodeficiency virus (HIV) infection in industrialized nations, and life expectancies associated with the infection have increased. However, infection rates have generally remained unchanged, with increases noted among certain subpopulations. The use of systemic preexposure prophylaxis for HIV infection has been proposed as an intervention to reduce the risk of disease transmission in at-risk individuals. The basis of this prophylaxis involves the orchestrated use of antiretrovirals in uninfected individuals either continuously or just before high-risk situations, such as perinatal and occupational exposure to HIV, in order to reduce the likelihood of successful HIV infection. Data from the use of antiretrovirals to prevent HIV infection in these scenarios support the concept of preexposure prophylaxis. Preliminary animal studies have focused on the use of antiretrovirals to prevent simian immunodeficiency virus infection in macaque monkeys, and these data have provided support for the potential efficacy of preexposure prophylaxis for HIV in humans. Limited human data are available, however, but studies are ongoing. Clinical trials have focused on the use of tenofovir disoproxil fumarate either alone or in combination with emtricitabine. Tenofovir-emtricitabine-based regimens may be ideal, given the drugs' pharmacodynamic and pharmacokinetic properties. Some investigators have surveyed at-risk individuals to assess their knowledge of preexposure prophylaxis and whether they used or intended to use this prevention strategy. Routine use of preexposure prophylaxis and even knowledge of its existence appear to be very limited. If efficacy is proved, use of preexposure prophylaxis faces several ethical issues. Ultimately, its success will depend on proof of cost-effectiveness. Until the many questions concerning optimal use of preexposure prophylaxis for HIV are answered, however, its use should be limited to research-related clinical investigations.
抗逆转录病毒疗法显著改善了在工业化国家中人类免疫缺陷病毒（HIV）感染的典型病程，与该感染相关的预期寿命也有所提高。然而，感染率总体上保持不变，某些特定人群中有所增加。已提出使用全身性暴露前预防来预防 HIV 感染，作为减少高危人群中疾病传播风险的干预措施。这种预防的基础是在未感染个体中连续或仅在高危情况下（如围产期和职业性暴露于 HIV）协调使用抗逆转录病毒药物，以降低成功感染 HIV 的可能性。在这些情况下使用抗逆转录病毒药物预防 HIV 感染的数据支持暴露前预防的概念。初步的动物研究集中在使用抗逆转录病毒来预防猕猴的猴免疫缺陷病毒感染，这些数据为暴露前预防预防 HIV 在人类中的有效性提供了支持。然而，目前可用的人类数据有限，但正在进行研究。临床试验集中在使用富马酸替诺福韦二吡呋酯单独或与恩曲他滨联合使用。鉴于这些药物的药效学和药代动力学特性，替诺福韦-恩曲他滨方案可能是理想的方案。一些研究人员调查了高危人群，以评估他们对暴露前预防的了解程度，以及他们是否使用或打算使用这种预防策略。暴露前预防的常规使用，甚至对其存在的认识似乎非常有限。如果证明其有效，那么使用暴露前预防将面临几个伦理问题。最终，其成功将取决于成本效益的证明。在回答有关 HIV 暴露前预防的最佳使用的许多问题之前，其使用应仅限于与研究相关的临床研究。
