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Open Access Review

Challenges and opportunities for oral pre-exposure prophylaxis in the prevention of HIV infection: where are we in Europe?

Jean-Michel Molina13*, Claire Pintado3, Caroline Gatey3, Diane Ponscarme3, Pierre Charbonneau3, Benedicte Loze3, Willy Rozenbaum3 and Constance Delaugerre12

Author Affiliations

1 INSERM U941, University of Paris Diderot, Sorbonne Paris Cité, Paris, France

2 Laboratory of Virology, Hopital Saint Louis, AP-HP, Paris, France

3 Department of Infectious Diseases, Hopital Saint Louis, AP-HP, 1 avenue Claude Vellefaux, Paris 75010, France

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BMC Medicine 2013, 11:186  doi:10.1186/1741-7015-11-186

Published: 23 August 2013

Abstract

Following US Food and Drugs Administration approval in July 2012 of daily oral tenofovir and emtricitabine for pre-exposure prophylaxis (PrEP) to prevent HIV infection in high-risk individuals in the USA, there has been much controversy about the implementation of this PrEP regimen in other countries throughout the world, and in Europe in particular. In this review, we focus on the challenges and opportunities of a daily oral PrEP regimen to curb the rising incidence of HIV infection in high-risk groups, and particularly in men who have sex with men. A number of issues would need to be addressed before PrEP could be implemented, including assessing the real effectiveness and cost-effectiveness of daily PrEP, the sustainability of daily adherence, the risk of selecting resistance, the long-term safety, and the risk of change in sexual behavior that might offset the benefit of PrEP. Alternatives to a daily oral PrEP regimen are being explored.

Keywords:
HIV; Tenofovir; Emtricitabine; Men who have sex with men; Intermittent; PrEP; Adherence