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Potential role of PEP, PrEP and ART for HIV Prevention among Men who have Sex with Men

Potential role of PEP, PrEP and ART for HIV Prevention among Men who have Sex with Men . Frits van Griensven, PhD, MPH Division of HIV/AIDS Prevention US Centers for Disease Control and Prevention and Thailand MOPH - US CDC Collaboration .

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Potential role of PEP, PrEP and ART for HIV Prevention among Men who have Sex with Men

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  1. Potential role of PEP, PrEP and ART for HIV Prevention among Men who have Sex with Men Frits van Griensven, PhD, MPH Division of HIV/AIDS Prevention US Centers for Disease Control and Prevention and Thailand MOPH - US CDC Collaboration Disclaimer: The views expressed herein are solely the responsibility of the author and do not necessarily represent the official views of the CDC

  2. In this presentation 1) Non-occupational (or sexual) post exposure prophylaxis (NPEP) 2) Pre-post exposure prophylaxis or PrEP Oral Topical 3) Antiretroviral treatment for prevention

  3. Controls (n = 21) FTC/TFV daily (n=6) Efficacy of daily and pre- and post-exposure oral Truvada in preventing SHIV infection following rectal challenge in macaques 100 (HR>20, p<0.0001) FTC/TFV -2h/+22h (n=6) (HR>20, p<0.0001) 75 50 % Uninfected macaques 25 0 0 2 4 6 8 10 12 Number of weekly rectal exposures Garcia-Lerma et al, PLOS, 2008

  4. PrEP Initiative (iPrEx) • Men who have sex with men • Randomized 1:1 FTC/TDF vs Placebo • Daily oral • Followed for: • HIV seroconversion • Adverse Effects • Metabolic Effects • HBV exacerbations • Risk behavior and STIs (including HSV) • Adherence • If infected • Drug resistance • Viral load • Immunological responses and CD4 counts

  5. Intermittent PrEP (iPrep) • May be more in line with sexual life style • Reduce pill burden • Reduce drug burden • Reduce side-effects • Decrease costs • May increase adherence and coverage • And may be increase safer sex behavior • And is supported by animal models

  6. In the shadow of Caprisa

  7. Challenges for ARV prevention in MSM • Adherance • Risk compensation and behavioral disinhibition, individually and at the community level • Targeting and duration of programs • Programming outside the Western world • Implementation and programming in low HIV prevalence communities • Costs and competition with curation • Pill burden, drug burden, side-effects, toxicity, resistance • How to monitor impact

  8. In conclusion • PEP not ready for programmatic scale up, but good as an individual service on a case by case basis • Daily PrEP results expected soon; if efficacious, studies will try to identify non-inferior alternative regimens • Many implementation issues • Rectal PrEP – promising, but still long way to go • ART for prevention, seems reasonable, ecological evidence available, MSM transmission studies are urgently needed

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