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JAMA. 2018 Mar 27;319(12):1261-1268. doi: 10.1001/jama.2018.1917.

HIV Preexposure Prophylaxis: A Review.

Author information

Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor.
The Fenway Institute, Fenway Health, Boston, Massachusetts.
Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.



About 40 000 Americans and 2 million people worldwide are newly infected with HIV each year. The combination antiretroviral regimen, tenofovir disoproxil fumarate (TDF)/emtricitabine, taken as a single pill once daily, has been shown to prevent HIV transmission but is used by fewer than 20% of people who could benefit in the United States.


PubMed was searched on February 15, 2018, using the search terms pre-exposure, prophylaxis, HIV, and PrEP to identify English-language articles published between 2010 and 2018. Four placebo-controlled randomized clinical trials have demonstrated that preexposure prophylaxis (PrEP) with daily dosing of TDF/emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment. The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence. TDF/emtricitabine is safe and well-tolerated. Only 2% of people discontinue PrEP because of adverse effects. Sexually transmitted infections are common among those using PrEP. Resistance to TDF/emtricitabine when used for PrEP is rare (<0.1%) and usually occurs when PrEP is inadvertently prescribed to individuals with undiagnosed acute HIV infection who have false-negative findings on HIV antibody/antigen testing due to HIV infection acquired within 7 to 10 days of testing. Effective methods are needed to identify individuals at high risk for acquiring HIV, ensure their access to PrEP, and maximize medication adherence.

Conclusions and Relevance:

TDF/emtricitabine is an effective and safe therapy for preventing HIV transmission. Increasing prescription of TDF/emtricitabine for patients at risk of acquiring HIV has the potential to reduce new HIV infections.

[Indexed for MEDLINE]

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