Elion Richard, Coleman Megan
aGeorge Washington University School of Medicine bWhitman Walker Health, Washington, District of Columbia, USA.
Curr Opin HIV AIDS. 2016 Jan;11(1):67-73. doi: 10.1097/COH.0000000000000222.
This article describes the use of tenofovir/emtricitabine (Truvada) as prevention for exposure to HIV [preexposure prophylaxis (PrEP)] infection in the USA. The use of PrEP and the challenges of implementation are very instructive as other countries adopt this intervention and it becomes a fundamental part of worldwide efforts for HIV prevention and much can be learned from the first 3 years in the USA.
Randomized trials and demonstration projects have shown the benefits of PrEP for men and women who are at risk for HIV. Numerous studies have showed that the level of prevention is excellent when the drug is taken at least four times weekly, once adequate levels are obtained. However, adherence remains a critical issue as well as tailoring delivery models for specific populations. Six recent studies are discussed, that support excellent efficacy and significantly support PrEP as a means of prevention. These projects have shown high acceptance of PrEP with excellent adherence by individuals demonstrated by those at risk remaining free of HIV over extended periods of time.
The USA faces three significant challenges in scaling up PrEP. The first challenge in implementation in the USA is to get individuals to recognize the actual risks that their behaviors represent and to engage with providers to address these issues. The second challenge is getting a population of providers to recognize the exact same issues and offer PrEP in a compassionate, nonjudgmental fashion. The third challenge is identifying the set of providers and locations to scale-up the response in a timely, cost-effective fashion.
本文描述了在美国使用替诺福韦/恩曲他滨（特鲁瓦达）预防艾滋病毒暴露前预防（PrEP）感染的情况。随着其他国家采用这种干预措施并使其成为全球艾滋病毒预防工作的重要组成部分，PrEP的使用及其实施挑战具有很大的指导意义，并且可以从美国的头三年中学到很多东西。
随机试验和示范项目表明，PrEP对有感染艾滋病毒风险的男性和女性有益。大量研究表明，当每周至少服用四次该药物并达到足够水平时，预防效果极佳。然而，依从性仍然是一个关键问题，同时还需要为特定人群量身定制给药模式。本文讨论了六项近期研究，这些研究支持了PrEP的卓越疗效，并显著支持将其作为一种预防手段。这些项目表明，PrEP的接受度很高，有风险的个体表现出极佳的依从性，在很长一段时间内都没有感染艾滋病毒。
美国在扩大PrEP使用规模方面面临三个重大挑战。在美国实施PrEP的第一个挑战是让个体认识到其行为所代表的实际风险，并与医疗服务提供者合作解决这些问题。第二个挑战是让一群医疗服务提供者认识到同样的问题，并以富有同情心、不评判的方式提供PrEP。第三个挑战是确定一组医疗服务提供者和地点，以便及时、经济高效地扩大应对措施的规模。
