Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor.
JAMA. 2018 Mar 27;319(12):1261-1268. doi: 10.1001/jama.2018.1917.
About 40 000 Americans and 2 million people worldwide are newly infected with HIV each year. The combination antiretroviral regimen, tenofovir disoproxil fumarate (TDF)/emtricitabine, taken as a single pill once daily, has been shown to prevent HIV transmission but is used by fewer than 20% of people who could benefit in the United States.
PubMed was searched on February 15, 2018, using the search terms pre-exposure, prophylaxis, HIV, and PrEP to identify English-language articles published between 2010 and 2018. Four placebo-controlled randomized clinical trials have demonstrated that preexposure prophylaxis (PrEP) with daily dosing of TDF/emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment. The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence. TDF/emtricitabine is safe and well-tolerated. Only 2% of people discontinue PrEP because of adverse effects. Sexually transmitted infections are common among those using PrEP. Resistance to TDF/emtricitabine when used for PrEP is rare (<0.1%) and usually occurs when PrEP is inadvertently prescribed to individuals with undiagnosed acute HIV infection who have false-negative findings on HIV antibody/antigen testing due to HIV infection acquired within 7 to 10 days of testing. Effective methods are needed to identify individuals at high risk for acquiring HIV, ensure their access to PrEP, and maximize medication adherence.
TDF/emtricitabine is an effective and safe therapy for preventing HIV transmission. Increasing prescription of TDF/emtricitabine for patients at risk of acquiring HIV has the potential to reduce new HIV infections.
每年约有 40000 名美国人和 200 万全球新感染艾滋病毒。替诺福韦二吡呋酯（TDF）/恩曲他滨的组合抗病毒方案，作为每日一片的单一药物，已被证明可预防艾滋病毒传播，但在美国，能够受益的人群中只有不到 20%的人使用。
2018 年 2 月 15 日在 PubMed 上进行了检索，使用了“暴露前、预防、HIV 和 PrEP”等搜索词，以确定 2010 年至 2018 年期间发表的英文文章。四项安慰剂对照随机临床试验表明，每日 TDF/恩曲他滨预防暴露（PrEP）可显著降低男男性行为者、高风险异性恋者和共用注射设备的注射吸毒者的 HIV 感染率。每日 TDF/恩曲他滨的疗效超过 90%，但与依从性高度相关。TDF/恩曲他滨是安全且耐受良好的。只有 2%的人因不良反应而停止 PrEP。PrEP 使用者中常见性传播感染。当用于 PrEP 时，TDF/恩曲他滨的耐药性很少见（<0.1%），并且通常发生在 PrEP 被意外开给因 HIV 感染而出现假阴性结果的未经诊断的急性 HIV 感染者时，HIV 抗体/抗原检测感染发生在检测后 7 至 10 天内。需要有效的方法来确定有感染 HIV 高风险的个体，确保他们获得 PrEP，并最大限度地提高药物依从性。
TDF/恩曲他滨是预防 HIV 传播的有效且安全的治疗方法。增加高危人群中 TDF/恩曲他滨的处方，有可能减少新的 HIV 感染。
