Service des maladies infectieuses et tropicales, Hôpital Saint Louis, APHP, Paris, France, Inserm U941, Université Paris Diderot, Paris VII, France
- Key words: prevention, HIV, tenofovir emtricitabine, pre-exposure prophylaxis
- DOI : 10.1684/jpc.2013.0254
- Page(s) : 134-42
- Published in: 2013
Combined strategies are needed to contain the HIV epidemic. Pre-exposure prophylaxis has been already used to prevent mother-to-child transmission of HIV. High risk groups of HIV acquisition are targeted by this new HIV prevention strategy. In these groups usual behavioural prevention strategies like condoms are not sufficient anymore. The oral nucleoside combination of emtricitabine-ténofovir (Truvada
®) is the most frequent combination used in PrEP in trials. PrEP studies with Truvada
® have been performed in different high risk populations (men who have sex with men, serodiscordants partners, heterosexual men and women…) in low and high incomes countries. PrEP efficacy had been proved in animals studies but in phase III clinical trials, results have been conflicting. The PrEP strategy must associate behavioural counseling, screening and treatment for others sexually transmitted infections. Intermittent PrEP strategies are being evaluated to improve treatment adherence which is the key for PrEP success. Safety and virologic resistance data must be monitored in these healthy populations. Although approved recently by the FDA in the US, PrEP is not approved in France but is being investigated in an ANRS trial.