Department of Global Health, University of Washington, USA.
Annu Rev Med. 2013;64:219-32. doi: 10.1146/annurev-med-050911-163701. Epub 2012 Sep 27.
Pre-exposure prophylaxis (PrEP), in which HIV-uninfected persons use oral or topical antiretroviral medications to protect against HIV acquisition, is a promising new HIV prevention strategy. The biologic rationale for evaluation of PrEP for sexual HIV prevention included nonhuman primate models and the efficacy of antiretroviral prophylaxis for HIV-exposed infants. Proof-of-concept that PrEP protects against sexual HIV acquisition has been demonstrated in four clinical trials, which used the antiretroviral medication tenofovir, either as a vaginal gel or as daily oral tenofovir disoproxil fumarate, alone or coformulated with emtricitabine. Importantly, however, two trials failed to demonstrate HIV protection with PrEP; low adherence to daily use of PrEP is the leading hypothesis to account for the lack of efficacy. Next steps in the field include rigorous evaluation of uptake and adherence to PrEP in implementation settings and research into next-generation PrEP agents with longer half-life and less user dependence.
暴露前预防（PrEP）是指 HIV 阴性者使用口服或局部抗逆转录病毒药物来预防 HIV 感染，是一种有前途的新的 HIV 预防策略。评估 PrEP 用于性 HIV 预防的生物学依据包括非人类灵长类动物模型和抗逆转录病毒预防 HIV 暴露婴儿的疗效。四项临床试验证明了 PrEP 可预防性 HIV 感染，这些试验使用了抗病毒药物替诺福韦，无论是阴道凝胶还是每日口服替诺福韦二吡呋酯，单独使用或与恩曲他滨联合使用。然而，重要的是，两项试验未能证明 PrEP 具有 HIV 保护作用；每日使用 PrEP 的低依从性是解释其无效的主要假设。该领域的下一步包括在实施环境中严格评估 PrEP 的采用和依从性，以及研究半衰期更长、对使用者依赖性更小的下一代 PrEP 药物。
