Efficacy of preexposure prophylaxis for HIV-1 prevention among high-risk heterosexuals: subgroup analyses from a randomized trial

被引：119

作者：

Murnane, Pamela M. ^{[1
,2
]}

Celum, Connie ^{[1
,2
,3
]}

Mugo, Nelly ^{[2
,4
,5
]}

Campbell, James D. ^{[6
,7
]}

Donnell, Deborah ^{[2
,8
]}

Bukusi, Elizabeth ^{[2
,4
,5
]}

Mujugira, Andrew ^{[2
]}

Tappero, Jordan ^{[9
]}

Kahle, Erin M. ^{[1
,2
]}

Thomas, Katherine K. ^{[2
]}

Baeten, Jared M. ^{[1
,2
,3
]}

机构：

[1] Univ Washington, Dept Epidemiol, Seattle, WA 98104 USA

[2] Univ Washington, Dept Global Hlth, Seattle, WA 98104 USA

[3] Univ Washington, Dept Med, Seattle, WA 98104 USA

[4] Univ Nairobi, Dept Obstet & Gynaecol, Nairobi, Kenya

[5] Kenyatta Natl Hosp, Dept Obstet & Gynaecol, Nairobi, Kenya

[6] CDC Uganda, Natl Ctr HIV Viral Hepatitis STD & TB Prevent, Div HIV AIDS Prevent, Entebbe, Uganda

[7] Univ Maryland, Sch Med, Ctr Vaccine Dev, Div Infect Dis & Trop Pediat,Dept Pediat, Baltimore, MD 21201 USA

[8] Fred Hutchinson Canc Res Ctr, Stat Ctr HIV AIDS Res & Prevent, Seattle, WA 98104 USA

[9] Ctr Dis Control & Prevent, Atlanta, GA USA

来源：

AIDS | 2013年 / 27卷 / 13期

基金：

美国国家卫生研究院;

关键词：

Africa; antiretroviral agents; HIV-1; acquisition; primary prevention; women; TRANSMISSION;

D O I：

10.1097/QAD.0b013e3283629037

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background:Daily oral antiretroviral preexposure prophylaxis (PrEP) is a promising strategy for prevention of HIV-1 acquisition. Three clinical trials demonstrated PrEP efficacy; however, two PrEP trials among women did not find protection against HIV-1. One hypothesis proposed for these divergent results is that PrEP efficacy may be reduced in populations with higher HIV-1 incidence.Methods:Using data from the Partners PrEP Study, a randomized, placebo-controlled trial of daily oral tenofovir (TDF) and emtricitabine/tenofovir (FTC/TDF) PrEP among heterosexual HIV-1 serodiscordant couples from Kenya and Uganda, we assessed PrEP efficacy among subgroups at higher risk for HIV-1 acquisition, including subgroups of women with high HIV-1 incidence.Results:The overall placebo arm HIV-1 incidence was 2.0 per 100 person-years. Among higher risk subgroups, placebo arm HIV-1 incidence ranged from 3.9 to 6.6 per 100 person-years. In all subgroups, PrEP was protective against HIV-1 acquisition, with efficacy point estimates ranging from 64 to 84%. Among subgroups of women with placebo-arm HIV-1 incidence more than 5.0, efficacy estimates ranged from 64 to 84%. Monthly visit attendance for PrEP refills and tenofovir detection in plasma were high.Conclusion:Among higher-risk subgroups in the Partners PrEP Study, including groups solely of higher-risk women, both TDF alone and combined FTC/TDF PrEP had consistently high efficacy for HIV-1 protection. PrEP, when used with high adherence, is a highly effective prevention strategy for higher risk heterosexuals. Prioritizing PrEP for persons at high risk of HIV-1 will maximize its prevention impact.

引用

页码：2155 / 2160

页数：6

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