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HIV PrEP at CROI
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from Jules: You can't stop science. Upon the discovery years ago that tenofovir PrEP could prevent HIV transmission this was a train that should not & could not be stopped but had to be developed & its use refined, if used properly it can be useful in the HIV epidemic.....remember a key reason for PrEP's use is because other prevention methods have not been working in stemming new infections. Yes, adherence to taking PrEP is crucial to its success & without this adherence HIV transmission can occur, I refer you to the last 3 studies listed below, where adherence & dosing are discussed. So, you can't stop science, PrEP as a science can work, its here, its important to work towards perfecting its use.
CROI: Provider Prescription of Pre-Exposure Prophylaxis (PrEP) for HIV Infection......PrEP is a powerful HIV prevention tool, yet....only one-fourth of U.S. providers who care for both HIV-infected and non-HIV-infected patients reported ever prescribing PrEP based on interim guidance...........Data on provider uptake of interim PrEP guidance......U.S. care providers were surveyed during June 2013-January 2014 to estimate the weighted prevalence of ever prescribing PrEP and to describe patients for whom PrEP was prescribed
CROI: U.S. Population Benefits of HIV Preexposure Prophylaxis for Injection Drug Users - (03/30/15)....researchers modeled the benefits and cost-effectiveness of PrEP for IDUs...."has the potential to be valuable intervention..."
CROI: Enrollment and preliminary follow-up of injecting drug users receiving pre-exposure prophylaxis in Bangkok - (03/30/15)
CROI: Recent increases in PrEP Utilization at a Boston Community Health Canter 2011-2014: Transition from Research to Clinical Practice - (03/30/15)
CROI: Barriers to Effective Prevention: Applying a PrEP Care Continuum to a US Cohort of Black and White MSM - (03/30/15)
CROI: Phase 1 Safety & PK Trial of Polyurethane Tenofovir Disoproxil Fumarate Vaginal Ring - (03/30/15)
Of course a MAJOR theme out of CROI 2015: PrEP studies presented at CROI reported high HIV prevention rates
CROI: As-Needed PrEP Cuts HIV Rate 86% in French-Canadian Ipergay Trial - written by Mark Mascolini - (02/25/15)
CROI: Pre-Exposure Prophylaxis for HIV Prevention: What we know and What we still need to know for implementation - (02/25/15) excellent plenary lecture by Rafael Landovitz, MD UCLA
CROI: Daily TDF/FTC PrEP Provides 86% Protection From HIV in Gay British Men - (02/25/15)
CROI: As-Needed PrEP Cuts HIV Rate 86% in French-Canadian Ipergay Trial - full slide presentation below (02/25/15)
CROI: PrEP plus ART yields "near elimination" of HIV in Partners cohort - (02/25/15)
CROI: Wider PrEP Use in San Francisco Could Cut New HIV Rate by 70% - (02/25/15).......New HIV infections in San Francisco could fall by 70% from 429 yearly in 2011 to about 125 yearly if about 14,000 city residents used preexposure prophylaxis (PrEP) yearly, according to a modeling study [1]. HIV incidence could fall even faster if viral suppression rates rise from a currently estimated 62% to 90% of people with HIV. But although PrEP use began to climb in San Francisco in 2013, PrEP uptake remains below one third the number needed to reach the 70% lower new-infection rate.
CROI: Tenofovir vaginal gel fails to protect women from HIV in phase 3 placebo trial - (04/01/15)
CROI: Cabotegravir (GSK744) and Rilpivirine As 2-Drug Oral Maintenance Therapy: LATTE W96 Results - (03/05/15)
Long-Acting PrEP
CROI/2014: Long-Acting Integrase Inhibitor GSK744 for PrEP (Once Monthly or maybe longer).....http://www.natap.org/2014/CROI/croi_32.htm......."These data support moving GSK744 LA into clinical evaluation as PrEP in high-risk men who have sex with men - Phase 2 safety and tolerability studies commence in Spring 2014....These data support the evaluation of GSK744 LA as PrEP in other challenge models - Low---dose intravaginal (40LB see link to this CROI webcast below) and high--dose intravaginal (941LB)"
HIV Prevention (PrEP) at CROI 2015 - Jared Baeten, MD PhD Connie Celum, MD MPH University of Washington - (03/12/15)
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Adherence/how many Tenofovir PrEP pills worked in study - Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.....iPrEx open-label extension.....The Lancet Infectious Diseases, September 2014.......http://www.natap.org/2014/HIV/092914_05.htm ......."Drug concentrations in dried blood spots were strongly associated with HIV incidence among those receiving PrEP (figure 2). There were no infections at visits where tenofovir diphosphate concentration was 700 fmol per punch or greater, suggesting the use of four to seven tablets per week (table 2). Such protective drug concentrations were evident during 33% of visits among those receiving PrEP. The hazard ratio for infection was 0·00 (95% CI 0·00-0·17) compared with the previous placebo group and 0·00 (0·00-0·14; adjusted for baseline differences in HIV risk factors) compared with concurrent off-PrEP group. The dried blood spot concentration associated with 90% reduced risk of HIV acquisition relative to the off-PrEP group was 611 fmol per punch (95% CI 216-1006), consistent with use of two or three tablets per week."
CROI/2014: Estimated Time to Protection and Duration of Protection With Daily TDF/FTC PrEP......http://www.natap.org/2014/Pharm/Pharm_05.htm
Dose Response for Starting and Stopping HIV Preexposure Prophylaxis for Men Who Have Sex With Men - (02/23/15).......Clin Infect Dis. (March 1 2015)......"In summary, this study indicates that approximately 1 week of daily PrEP is expected to confer high PrEP activity for MSM. Although a high level of protection may persist for several days after stopping PrEP from steady state, 4 weeks of continued PrEP dosing is reasonable relative to the last potential HIV exposure."
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