Department of Global Health, University of Washington, Seattle, WA 98104, USA.
J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2(0 2):S122-9. doi: 10.1097/QAI.0b013e3182986f69.
Preexposure prophylaxis (PrEP), in which HIV-uninfected persons with ongoing HIV risk use antiretroviral medications to reduce their risk of acquiring HIV infection, is an efficacious and promising new HIV prevention strategy. The past 2 years have seen significant new advances in knowledge regarding PrEP, including definitive demonstration that PrEP reduces the risk of HIV acquisition, regulatory approval of combination oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) as the first PrEP agent with a label indication for sexual HIV prevention, and the development of normative guidance for clinical prescribing of PrEP. In PrEP clinical trials, HIV protection was strongly correlated with PrEP adherence; therefore, understanding and supporting adherence to PrEP are key to maximizing its public health impact. As would be expected for any new HIV prevention approach, questions remain, including how to motivate uptake of and sustain adherence to PrEP for HIV prevention in high-risk populations, how much use is sufficient to achieve HIV protection, and the potential of "next-generation" PrEP agents to improve this effective prevention strategy. At this important transition point-from demonstration of efficacy in clinical trials to thinking about implementation and effectiveness-this review addresses where we have been and where we are going with PrEP for HIV prevention.
暴露前预防（PrEP）是指未感染 HIV 的具有持续 HIV 风险的人群使用抗逆转录病毒药物来降低感染 HIV 的风险，这是一种有效且有前途的新的 HIV 预防策略。在过去的两年中，关于 PrEP 的知识取得了重大的新进展，包括明确证明 PrEP 可降低 HIV 感染的风险，监管部门批准将复方口服恩曲他滨/替诺福韦酯（FTC/TDF）作为首个具有性传播 HIV 预防标签适应证的 PrEP 药物，以及制定了 PrEP 临床处方的规范指南。在 PrEP 临床试验中，HIV 保护与 PrEP 依从性密切相关；因此，了解和支持 PrEP 依从性是最大限度发挥其公共卫生影响的关键。正如任何新的 HIV 预防方法一样，仍然存在一些问题，包括如何在高危人群中激发和维持对 PrEP 用于 HIV 预防的接受度和依从性，需要多少使用量才能实现 HIV 保护，以及“下一代”PrEP 药物在改善这一有效预防策略方面的潜力。在这一重要的转折点——从临床试验中证明疗效到考虑实施和有效性——这篇综述讨论了我们在 PrEP 预防 HIV 方面的进展和未来方向。
