Irie Whitney C, Nicol Melanie R, Clement Meredith, Bukusi Elizabeth Anne, Bekker Linda-Gail, Molina Jean-Michel, Stewart Jenell
Boston College and Harvard Medical School, Chestnut Hill, MA, USA.
University of Minnesota College of Pharmacy, Minneapolis, MN, USA.
Lancet HIV. 2025 Feb;12(2):e143-e153. doi: 10.1016/S2352-3018(24)00300-X. Epub 2025 Jan 6.
Despite advancements in existing antiretroviral-based prevention strategies, including daily oral, locally acting, and injectable options, there is a pressing need for more inclusive and flexible event-driven pre-exposure prophylaxis (PrEP) strategies for all. Event-driven or intermittent dosing of PrEP in populations beyond cisgender men who have sex with men would offer a promising alternative by fitting prevention into the diverse lifestyles of affected populations and thereby advancing health equity. Evidence from PrEP clinical trials, pharmacokinetic studies, modelling studies, and real-world observational research suggests that event-driven PrEP could be a flexible and inclusive option, yet optimal dosing has not been established across sex and gender spectrums. To advance PrEP equity through inclusivity, studies on event-driven PrEP should include people across the gender spectrum. Real-world demonstration studies and simulation studies of optimal dosing strategies are needed. While awaiting further evidence, clinical providers can offer shared decision making and counselling on available data to include event-driven dosing as an option, especially when daily oral, locally acting, or injectable PrEP are not acceptable or preferred methods. Wider access to diverse PrEP options for all populations fosters a more inclusive and effective global HIV prevention strategy.
尽管现有的基于抗逆转录病毒的预防策略取得了进展，包括每日口服、局部作用和注射用选项，但迫切需要为所有人制定更具包容性和灵活性的事件驱动型暴露前预防（PrEP）策略。在男同性恋者以外的人群中采用事件驱动或间歇性服用PrEP，通过使预防措施适应受影响人群的多样化生活方式，从而促进健康公平，将提供一个有前景的替代方案。来自PrEP临床试验、药代动力学研究、建模研究和现实世界观察性研究的证据表明，事件驱动型PrEP可能是一种灵活且具包容性的选择，但尚未在所有性别范围内确定最佳剂量。为了通过包容性推进PrEP公平性，关于事件驱动型PrEP的研究应涵盖所有性别群体的人群。需要进行现实世界示范研究和最佳剂量策略的模拟研究。在等待进一步证据的同时，临床提供者可以根据现有数据提供共同决策和咨询，将事件驱动型给药作为一种选择，特别是当每日口服、局部作用或注射用PrEP不可接受或不是首选方法时。为所有人群提供更广泛的多种PrEP选项有助于形成更具包容性和有效性的全球艾滋病毒预防策略。
