Andy Kaytes, on behalf of IFARA, spoke with Daniel Kuritzkes, M.D., David Wohl, M.D., and Kathleen Squires, M.D., about the future of antiretroviral therapy in HIV prevention. The strategy of using the same medication both for the treatment and prevention of a disease is also employed for malaria and other conditions. Only a few antiretroviral drugs have been studied for HIV prevention, notably tenofovir/emtricitabine (Truvada), but rates of protection have been very high. Another tenofovir prodrug, tenofovir alafenamide (TAF), affects the kidneys and bones less than tenofovir disoproxil fumarate and is equally effective in treating HIV. It is, however, unclear whether the U.S. Food and Drug Administration (FDA) will approve TAF for HIV prevention because the necessary studies comparing the two pro-drugs are "nearly impossible" to conduct, said Kuritzkes. Two exciting new developments in pre-exposure prophylaxis (PrEP) are a long-acting injectable form of tenofovir, as well as an insertable vaginal ring containing dapivirine. Squires pointed out the importance of "easy and cheap administration" of PrEP, because "the vast majority" of people affected by HIV live in resource-poor settings. A barrier to PrEP in the U.S., according to Wohl, is the reluctance of many primary care physicians to talk about sex with their patients. As a result, PrEP may not be prescribed, even if appropriate.
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About the panelists:
Daniel Kuritzkes, M.D., Brigham and Women's Hospital, Cambridge, Mass.
David Wohl, M.D., Division of Infectious Diseases, University of North Carolina.
Kathleen Squires, M.D., director of the Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia.