Pre-exposure prophylaxis for HIV prevention

Pre-exposure prophylaxis for HIV prevention, commonly known as PrEP, is the use of antiviral drugs as a strategy for the prevention of HIV/AIDS by people that do not yet have HIV/AIDS.^[1] PrEP is one of a number of HIV prevention strategies for people who are HIV-negative but who have a higher risk of acquiring HIV, including sexually-active adults who are at increased risk of contracting HIV, people who engage in intravenous drug use (see drug injection), and serodiscordant sexually-active couples.^[2]

The first form of PrEP for HIV prevention—emtricitabine and tenofovir disoproxil (FTC/TDF; Truvada)—was approved in 2012.^[3] In October 2019, the U.S. Food and Drug Administration (FDA) approved the combination of emtricitabine and tenofovir alafenamide (FTC/TAF; Descovy) to be used as PrEP in addition to Truvada, which provides similar levels of protection.^[4] Descovy, however, is currently approved only for cisgender males and transgender women as the efficacy has not been assessed in people at risk for HIV through receptive vaginal sex.^[2]

In December 2021, the FDA approved cabotegravir (Apretude), which is an injectable form of PrEP manufactured by Viiv Healthcare. Regulators believe it will improve medication adherence because it has to be taken just once every two months, and it will also widen adoption as it eliminates the need to hide pills or pharmacy visits for discretion.^[5]

In its 2021 guidelines, the World Health Organization (WHO) recommends multiple forms of PrEP for HIV prevention:^[6]

• Oral PrEP using TDF-containing compounds for anyone at substantial risk of HIV infection;
• Event-driven PrEP for men who have sex with men; and
• The dapivirine vaginal ring (DPV-VR) for women at substantial risk of HIV infection who do not have access to oral PrEP.^[6]

This article provides information regarding PrEP's medical uses, contraindications and side effects, societal and cultural perspectives on its usage, and recent research studies.