Efficacy estimates of oral pre-exposure prophylaxis for HIV prevention in cisgender women with partial adherence
File(s)Moore_Efficacy_Accepted.pdf (2.65 MB)
Accepted version
Author(s)
Type
Journal Article
Abstract
Pre-exposure prophylaxis (PrEP) with tenofovir (TFV) disoproxil fumarate and emtricitabine administered orally daily is effective in preventing human immunodeficiency virus (HIV) acquisition in both men and women with sufficient adherence; however, the adherence-efficacy relationship in cisgender women has not been well established. We calculated the adherence-efficacy curve for cisgender women by using HIV incidence and plasma TFV concentration data from three trials (FEM-PrEP, VOICE and Partners PrEP). We imputed TFV diphosphate (TFV-DP) concentrations, a measure of long-term adherence, from TFV quantification by using data from the HIV Prevention Trials Network 082 study, which measured both TFV-DP and TFV concentrations. Two, four and seven pills per week reduced HIV incidence by 59.3% (95% credible interval (CrI) 29.9-95.8%), 83.8% (95% CI 51.7-99.8%) and 95.9% (95% CI 72.6-100%), respectively. Our adherence-efficacy curve can be validated and updated by HIV prevention studies that directly measure TFV-DP concentrations. The curve suggests that high adherence confers high protection in cisgender women. However, the lower efficacy with partial adherence highlights the need for new PrEP products and interventions to increase adherence.
Date Issued
2023-11
Date Acceptance
2023-08-23
Citation
Nature Medicine, 2023, 29 (11), pp.2748-2752
ISSN
1078-8956
Publisher
Nature Research
Start Page
2748
End Page
2752
Journal / Book Title
Nature Medicine
Volume
29
Issue
11
Copyright Statement
© 2023, The Author(s), under exclusive licence to Springer Nature America, Inc. This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1038/s41591-023-02564-5
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37798438
PII: 10.1038/s41591-023-02564-5
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2023-10-05