Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet HIV. 2020 Oct;7(10):e721-e730. doi: 10.1016/S2352-3018(20)30203-4. Epub 2020 Aug 27.
When used appropriately, pre-exposure prophylaxis (PrEP) substantially reduces the risk of HIV acquisition. Early implementation outcomes often suggest poor PrEP adherence and persistence; however, this intervention is time-limited and the need for PrEP fluctuates as risk behaviours change. In this Viewpoint we examine the current guidelines and early programmatic outcomes after starting, stopping, and restarting PrEP, and we review the implications of PrEP in relation to HIV testing algorithms. Guidelines suggest to discontinue PrEP when a person is no longer at risk for HIV, but effectively implementing this strategy requires support tools to make the decision of stopping and restarting PrEP that considers the complex relationship between risk perceptions and risk behaviours. Safely discontinuing PrEP also requires greater understanding of the daily dosing duration that is needed to protect the person after their last HIV exposure. Additionally, clear strategies are needed to re-engage a person as their HIV exposure risk changes over time.
当正确使用时，暴露前预防（PrEP）可显著降低感染艾滋病毒的风险。早期实施结果通常表明 PrEP 用药的依从性和持久性较差；然而，这种干预是有限的，随着风险行为的变化，对 PrEP 的需求也会波动。在本观点中，我们检查了开始、停止和重新开始 PrEP 后的当前指南和早期方案结果，并审查了 PrEP 与 HIV 检测算法的关系。指南建议在一个人不再有感染艾滋病毒的风险时停止 PrEP，但有效实施这一策略需要支持工具，以做出停止和重新开始 PrEP 的决定，该决定需要考虑风险认知和风险行为之间的复杂关系。安全停止 PrEP 还需要更好地了解在最后一次 HIV 暴露后需要多长时间的每日剂量，以保护个人。此外，随着个人 HIV 暴露风险随时间的变化，还需要明确的策略来重新接触个人。
