WHAT’S NEW
Risk reduction nearly doubles
This is the first study to look at on-demand PrEP with TDF-FTC to decrease the incidence of HIV-1 infection in high-risk MSM. The risk reduction in this study (86%) was much better than the 44% seen in the prior study that used daily PrEP in this population.6 We suspect the increased benefit of on-demand PrEP is likely due to improved compliance with medication use.
CAVEATS
Can adherence be maintained?
The median length of follow-up in the study was 9.3 months. One concern is that adherence may wane over time, decreasing the efficacy of the prophylaxis. Continued efforts to improve compliance with this type of PrEP may be needed to ensure efficacy. Since the study was shortened and reported early, we need to wait for the results of the open-label study to fully assess the risk for adverse events.
CHALLENGES TO IMPLEMENTATION
Efficacy and convenience come at a cost
The main challenge to implementation could be the cost of the medication; the retail price of TDF-FTC is about $50 per dose.10 Insurance coverage for the medication varies.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
Copyright © 2016. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2016;65(8):556-558.