Pre-exposure Prophylaxis forHIV Infection in the Older Patient: What can be Recommended?

Abstract

Over the past 15years, a significant increase in newHIV/AIDS diagnoses has been observed in the elderly population. This new epidemiological shift has been attributed to a longer sex life, lifestyle and changes in sexual behavior, poor sexual health education, and misconceptions about the absence of sexually transmitted disease in later life. Although many biomedical and behavioral interventions have proven useful to prevent sexually transmitted infections andHIV, pre-exposure prophylaxis(PrEP) has been shown to be the most successful biomedical intervention to preventHIV in high-risk individuals. This approach is based on delivering a fixed dose of tenofovir disoproxil fumarate (300mg), alone or combined with emtricitabine (300/200mg) daily or on demand, before and after sexual intercourse. Despite the consistent number of clinical trials proving the effectiveness and safety of this strategy, no studies have focused specifically on elderly people. These individuals, who may benefit substantially from(PrEP), are at a higher risk of experiencing side effects secondary to tenofovir exposure. This review critically discusses the efficacy and safety ofPrEP in people aged over 50years and translates the knowledge of tenofovir management in patients withHIV into monitoring and stopping rules to be used in this special population. We provide practical recommendations to properly identifyPrEP candidates among older adults. Furthermore, we define correct case management before and during PrEP delivery, and we suggest stopping rules and alternative sexually transmitted infection prevention strategies.