Effectiveness and safety of oral HIV preexposure prophylaxis for all populations
Effectiveness and safety of oral HIV preexposure prophylaxis for all populations
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DOI：
10.1097/qad.0000000000001145
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发表时间：
2016-07-31
期刊：
影响因子：
3.8
通讯作者：
Grant, Robert M.
中科院分区：
文献类型：
--
作者：
Fonner, Virginia A.;Dalglish, Sarah L.;Grant, Robert M.
目的：暴露前预防（Preexposure prophylaxis，PrEP）为HIV的预防提供了新的途径。本系统性综述和荟萃分析评估了使用含富马酸替诺福韦酯的口服PrEP作为基于HIV感染、不良事件、耐药性、性行为和生殖健康结局的HIV高风险人群的额外HIV预防策略的证据。设计：严格的系统性综述和荟萃分析。一项综合检索策略审查了截至2015年4月的三个电子数据库和会议摘要。合并效果估计使用随机效应meta analysis.Results：18项研究被纳入，包括39篇文章和6个会议摘要的数据。在人群和PrEP方案中，与安慰剂相比，PrEP显著降低了HIV感染的风险。与安慰剂相比，使用PrEP超过70%的试验显示了最高的PrEP有效性（风险比= 0.30，95%置信区间：0.21-0.45，P < 0.001）。使用低PrEP的试验没有显示出显着的保护作用。PrEP和安慰剂组之间的不良事件相似。在急性HIV感染时启动PrEP的PrEP使用者中发现更多耐药HIV感染病例，但在PrEP使用期间获得耐药HIV的发生率较低。研究一致发现PrEP使用与性风险行为的变化之间没有关联。PrEP与妊娠相关的不良事件或激素避孕effectiveness.Conclusion：PrEP是预防艾滋病毒感染的人群，提出了一些重大的安全风险，并没有证据表明行为风险补偿。有效和具有成本效益地使用PrEP将需要制定最佳做法，以促进处于艾滋病毒高风险人群的吸收和坚持。版权所有（C）2016威科医疗集团All rights reserved.
Objective: Preexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.Design: Rigorous systematic review and meta-analysis.Methods: A comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.Results: Eighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.Conclusion: PrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.