Tenofovir-based oral preexposure prophylaxis prevents HIV infection among women.
Tenofovir-based oral preexposure prophylaxis prevents HIV infection among women.
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DOI：
10.1097/coh.0000000000000207
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发表时间：
2016-01
影响因子：
4.1
通讯作者：
Heffron R
中科院分区：
文献类型：
--
作者：
Thomson KA;Baeten JM;Mugo NR;Bekker LG;Celum CL;Heffron R
尽管作为女性控制的艾滋病毒预防策略有着巨大的前景，但在女性中实施暴露前预防（PrEP）一直受到限制，部分原因是该人群随机试验的不同疗效结果。本综述综合了现有的证据，关于PrEP有效预防妇女艾滋病毒感染和考虑提供PrEP妇女。在男性和女性中进行的三项疗效试验中，基于替诺福韦的口服PrEP在意向治疗分析中将女性亚组的HIV感染率降低了49-79%，在考虑PrEP依从性时降低了>85%。两项试验并未证明PrEP对女性的艾滋病毒预防益处，但大量证据表明这些结果受到研究药物依从性极低的影响。定性研究已经确定风险认知、耻辱感和临床试验参与方面影响研究药物的依从性。药代动力学研究提供了支持性证据，证明PrEP为坚持用药的女性提供了艾滋病毒保护。基于替诺福韦的每日口服PrEP可预防女性感染艾滋病毒。提供PrEP作为艾滋病毒感染高风险妇女的艾滋病毒预防选择是公共卫生的当务之急，需要有机会评估PrEP妇女的实施战略。
Despite tremendous promise as a female-controlled HIV prevention strategy, implementation of pre-exposure prophylaxis (PrEP) among women has been limited, in part because of disparate efficacy results from randomized trials in this population. This review synthesizes existing evidence regarding PrEP efficacy for preventing HIV infection in women and considerations for delivering PrEP to women. In three efficacy trials, conducted among men and women, tenofovir-based oral PrEP reduced HIV acquisition in subgroups of women by 49–79% in intent-to-treat analyses, and by >85% when accounting for PrEP adherence. Two trials did not demonstrate an HIV prevention benefit from PrEP in women, but substantial evidence indicates those results were compromised by very low adherence to the study medication. Qualitative research has identified risk perception, stigma, and aspects of clinical trial participation as influencing adherence to study medication. Pharmacokinetic studies provide supporting evidence that PrEP offers HIV protection in women who are adherent to the medication. Tenofovir-based daily oral PrEP prevents HIV acquisition in women. Offering PrEP as an HIV prevention option for women at high risk of HIV acquisition is a public health imperative and opportunities to evaluate implementation strategies for PrEP for women are needed.