Abstract
Background: Pre-exposure prophylaxis (PrEP) is used as an HIV prevention method by people at substantial risk of HIV infection. This systematic review and meta-analysis evaluates current clinical evidence for use of oral TDF-based PrEP among men who have sex with men.Methods: A comprehensive literature search in PubMed, web of science, Google Scholar and ClinicalTrials.gov was performed. A random-effects meta-analysis was conducted using the event rate (ER) for estimation of the incidence of HIV and grade 3 or 4 adverse events (AE) among PrEP arm and using risk ratio (RR) for comparison of incidence of HIV and grade 3 or 4 AE between PrEP recipients and PrEP non-users. Blood-based adherence levels were also divided into three categories with reference to previous meta-analysis. Subgroup meta-analysis was also performed to evaluate whether blood-based adherence levels moderated the effect of TDF-based PrEP on HIV incidence. Narrative review was used due to inconsistent measurements of risk behavior and drug resistance. This review is registered on the PROSPERO database (CRD42017077965).Results: Fourteen studies were included in the review. Oral TDF-based PrEP significantly reduced HIV incidence with minimum drug resistance and tolerable safety risks (HIV incidence, ER = 1.1%, 95% CI 0.6–2.0%, p < 0.001, RR = 0.244, 95% CI 0.111–0.537, p < 0.001 and grade 3 or 4 AEs, ER = 13.0%, 95% CI 9.9–16.9%, p < 0.001, RR = 1.059, 95% CI 0.824–1.362, p = 0.653). Oral TDF-based PrEP was more effective in reducing HIV incidence with high levels of blood-based PrEP adherence (ER, 0.4%) compared to moderate adherence (2.9%; p < 0.001). Most studies found no association between PrEP use and self-reported sexual behavior.Conclusion: Oral TDF-based PrEP is an effective intervention to prevent against HIV infection among MSM. Well-designed implementation science studies that integrate sociobehavioral and biomedical interventions are needed to identify optimal PrEP delivery models in different populations to translate biomedical efficacy into real-world efficacy.
Highlights
Around 1.8 million people became newly infected with HIV in 2016 globally, according to the Joint United Nations Program on HIV/AIDS (UNAIDS, 2016), indicating that tremendous efforts are needed to slow down the AIDS epidemic
Our systematic review shows that Pre-exposure prophylaxis (PrEP) significantly reduced HIV incidence, with low rates of HIV incidence among PrEP users, indicating the utility of this biomedical HIV prevention intervention in curbing HIV transmission among MSM
The findings in this meta-analysis are consistent with a previous review that evaluated the efficacy of PrEP across all populations (Fonner et al, 2016)
Summary
Around 1.8 million people became newly infected with HIV in 2016 globally, according to the Joint United Nations Program on HIV/AIDS (UNAIDS, 2016), indicating that tremendous efforts are needed to slow down the AIDS epidemic. In 2012, WHO first published a PrEP guidance, which recommended the use of tenofovir (TDF) and emtritabine (FTC) for people who are at substantial risk for HIV (such as serodiscordant couples and MSM). Daily use of PrEP by populations at high risk of HIV infection has been recommended in guidelines from United States, Europe, Australia and South Africa. Previous meta-analyses and systematic reviews have indicated that while TDF/FTC-based oral PrEP protects (Fonner et al, 2016; Desai et al, 2017), the efficacy of PrEP may vary across populations. This systematic review and meta-analysis evaluates current clinical evidence for use of oral TDF-based PrEP among men who have sex with men
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
