A systematic review of twelve trials, in a total of about 18 000 patients at high risk of HIV infection, evaluated pre-exposure prophylaxis (PrEP) using a combination of emtricitabine + tenofovir. In the trials in which estimated adherence was at least 70, the risk of HIV infection was clearly reduced, at a cost of adverse effects which were generally acceptable. Prevention of human immunodeficiency virus (HIV) transmission by taking medication, also called pre-exposure prophylaxis (PrEP), is offered to people who want to reduce the risk of becoming infected by this virus during the course of high-risk sexual practices, or needle sharing during drug use (1). In 2017, the initial evaluation of the emtricitabine + tenofovir combination established that it is a useful option in this setting (1). In 2019, the US Preventive Services Task Force (USPSTF), a public body in the United States that evaluates prevention strategies, published a systematic review with meta-analysis updating the initial assessment of these two HIV nucleoside/nucleotide reverse transcriptase inhibitors in this setting (2,3). Twelve randomised trials, 11 of which were placebo-controlled, evaluated the efficacy of tenofovir, or the combination of emtricitabine + tenofovir, in a total of 18 244 adults, with follow-up ranging from 4 months to 4 years. The trials including people who have heterosexual sex were all conducted in Africa. The trials including men who have sex with men were carried out in the United States, Canada and Europe. One trial evaluated treatment among injection drug users in Thailand. A single trial, carried out in 400 people in France and Canada, evaluated the use of on-demand treatment during a period of sexual activity. In all the other trials, treatment was continuous. No trial included pregnant women. Adherence to treatment was assessed by plasma assays or tablet counting (2).
展开▼
