Markley John D
Virginia Commonwealth University, Richmond, VA, USA.
Linacre Q. 2024 Nov;91(4):386-402. doi: 10.1177/00243639241239068. Epub 2024 Mar 21.
Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. However, there are several limitations to this strategy that are underrecognized. This article reviews the primary literature supporting the use of PrEP and explores the unintended consequences associated with its use. Current public health messaging indicates that PrEP reduces the risk of HIV transmission during sex by 99 percent; however, this figure is based on modeling rather than study findings, and real-world efficacy may be significantly lower. PrEP has been associated with increased rates of sexually transmitted infections, risk compensation, HIV drug resistance, low adherence, and drug side effects. To make fully informed decisions, medical professionals and patients should be aware of these pitfalls. Additionally, this article explores the bioethical implications of prescribing PrEP from a Catholic perspective. Although not always morally illicit, PrEP is most often prescribed in the context of sexual activity outside of marriage between a biological male and female, placing the prescriber in cooperation with activity deemed to be immoral by the Catholic Church. While all medical professionals seeking the common good should aim to reduce the transmission of HIV, not all means are morally licit. Conscience protection for medical professionals opposed to this strategy has become increasingly relevant. Thoughtful discernment is necessary when considering PrEP. The use of CDC material (figure 1) in this article does not imply endorsement by CDC. The material is in the public domain and available on the CDC website free of charge.
公共卫生当局广泛推行一种名为暴露前预防（PrEP）的策略，用于在高风险性行为和注射吸毒背景下预防人类免疫缺陷病毒（HIV）传播。然而，该策略存在一些未得到充分认识的局限性。本文回顾了支持使用PrEP的主要文献，并探讨了与使用PrEP相关的意外后果。当前的公共卫生信息表明，PrEP可将性行为期间HIV传播风险降低99%；然而，这一数字是基于模型而非研究结果，实际效果可能显著更低。PrEP与性传播感染率上升、风险补偿、HIV耐药性、依从性低以及药物副作用有关。为了做出充分知情的决策，医学专业人员和患者应了解这些陷阱。此外，本文从天主教的角度探讨了开具PrEP的生物伦理含义。虽然PrEP并非总是在道德上非法，但它最常被用于生物学意义上的男性和女性非婚姻性行为的背景下，这使得开药者参与了被天主教会视为不道德的活动。虽然所有追求共同利益的医学专业人员都应旨在减少HIV传播，但并非所有手段在道德上都是合法的。保护反对该策略的医学专业人员的良知变得越来越重要。在考虑PrEP时，进行深思熟虑的辨别是必要的。本文中使用的美国疾病控制与预防中心（CDC）的资料（图1）并不意味着得到了CDC的认可。该资料属于公共领域，可在CDC网站上免费获取。
