Would You Recommend Preexposure Prophylaxis for HIV Prevention?

Posted by • August 2nd, 2012

In our latest Clinical Decisions, two patients— a 46-year-old man from New York who has sex with men and an 18-year-old heterosexual woman with multiple partners in South Africa — are at risk for infection with HIV.  Would you recommend preexposure prophylaxis (PrEP)?

This question comes on the heels of three large studies of oral TDF and TDF-FTC for HIV prophylaxis recently published in NEJM. The Partners PrEP Trial and the TDF2 Study both showed benefit; the FEM-PrEP Study did not.  An editorial from the University of North Carolina’s Dr. Myron Cohen and NEJM editor Dr. Lindsey Baden sheds some light on the findings.

Following the presentation of our Clinical Decisions cases, a short essay from Dr. Salim Abdool Karim (from the Centre for the AIDS Program of Research in South Africa (CAPRISA), the University of KwaZulu-Natal in Durban, South Africa, and Columbia University) recommends initiating pre-exposure prophylaxis.  In a second essay, Drs. Glenda E. Gray and Neil Martinson (University of the Witwatersrand, Johannesburg) do not recommend initiating PrEP.

Which one of the approaches would you find appropriate for these patients? Base your choice on the published literature, your own experience, recent guidelines, and other sources of information, as appropriate.

Read the case descriptions, the essays and then cast your vote. Comments and the poll are open through Wednesday, August 8th.

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