当前和未来的 PrEP 药物和模式：按需、注射剂和局部用药。
Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals.
机构信息
Department of Health and Mental Health Services, Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 114-E, Los Angeles, CA, 90028, USA.
Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, 337 Charles E Young Drive East, Los Angeles, CA, 90095, USA.
出版信息
Curr HIV/AIDS Rep. 2019 Aug;16(4):349-358. doi: 10.1007/s11904-019-00450-9.
Abstract
PURPOSE OF REVIEW
Pre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation.
RECENT FINDINGS
Injectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use. On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.
摘要
目的综述
暴露前预防（PrEP）是一种有效的艾滋病病毒预防策略，但每日口服 PrEP 的使用率仍然很低。本文综述了目前可用的 PrEP 药物以及正在研究的药物和方法。
最近的发现
注射用抗逆转录病毒药物制剂在使用者中具有较高的可接受性，但可能需要按照 8 周间隔进行注射。在疗效研究中，局部杀微生物剂凝胶和阴道环的疗效按照意向治疗分析结果表现不佳，至少在很大程度上是由于在坚持和/或持续使用方面存在挑战。然而，与预期相比，每日口服 TDF-FTC 在随机、安慰剂对照试验中的表现也不如人意，随后在实际应用中也表现不佳。在临床试验中，按需（男男性行为者的 2-1-1 给药方案）和注射用 PrEP 似乎在参与者中是可以接受的。对于那些不想服用每日药物（包括按需和注射用）或不想长期承诺服用 PrEP（按需）的人来说，这些方法是特别有吸引力的替代方法。阴道贴膜、微针和皮下植入物等新兴方法具有许多优势，但仍处于早期开发阶段。
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