Expert faculty Jared Baeten, MD, PhD; Susan Buchbinder, MD; Connie L. Celum, MD, MPH; and Albert Liu, MD, MPH review emerging data on pre-exposure prophylaxis and antiretroviral therapy as prevention and discuss implications for community providers.

1. PrEP and My Patients: Guidance for
LGBT Community–Based Primary Care
Providers on Novel Strategies to Reduce
Risk of HIV Acquisition
This program is supported by an educational grant from
Originally posted 5/21/2012 at clinicaloptions.com/ss/PrEPGuidance

2. PrEP and My Patients
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3. PrEP and My Patients
clinicaloptions.com/hiv
Faculty Who Contributed to This Program
Susan Buchbinder, MD Jared M. Baeten, MD, PhD
Associate Clinical Professor Associate Professor
Departments of Medicine, Department of Global Health
Epidemiology, and and Medicine
Biostatistics University of Washington
University of California, Seattle, Washington
San Francisco
Director, HIV Research Section
San Francisco Department of
Public Health
San Francisco, California

4. PrEP and My Patients
clinicaloptions.com/hiv
Faculty Who Contributed to This Program
(cont’d)
Connie Celum, MD, MPH Albert Liu, MD, MPH
Professor, Department of Assistant Clinical Professor
Global Health and Medicine Department of Medicine
University of Washington University of California,
Seattle, Washington San Francisco
Director, HIV Prevention
Intervention Studies
HIV Research Section
San Francisco Department of
Public Health
San Francisco, California

5. PrEP and My Patients
clinicaloptions.com/hiv
Disclosures
Jared M. Baeten, MD, PhD, has no significant financial
relationships to disclose.
Susan Buchbinder, MD, has no significant financial
relationships to disclose.
Connie L. Celum, MD, MPH , has no significant financial
relationships to disclose.
Albert L. Liu, MD, MPH, has no significant financial
relationships to disclose.

6. Antiretroviral Therapy for
Preventing HIV Acquisition:
Available Data and Ongoing Trials

7. PrEP Background

8. PrEP and My Patients
clinicaloptions.com/hiv
Using Antiretroviral Medications
for HIV-1 Prevention
PrEP PEP ART
Time of
Prior to exposure After infection
transmission
Advantages Advantages Advantages
 Demonstrated efficacy Shorter course than PrEP Clinical benefits and
reduced infectiousness
Challenges Challenges Challenges
 Adherence Limited data Scale up; resources
 Delivery Recognition of risk Long-term adherence
 Cost-effectiveness Initiation < 48 hrs Long term toxicity
 Resistance  Adherence Resistance
Public health impact

9. PrEP and My Patients
clinicaloptions.com/hiv
Tenofovir for PrEP
 Completed clinical trials of PrEP have tested tenofovir
– Oral TDF, oral TDF/FTC, vaginal gel
 Potent: rapid antiretroviral activity
 Safe: Substantial treatment safety experience
 Easy: Once-daily dosing, few drug-drug interactions
 Evidence that concept should work
– Animal models and postnatal prophylaxis of breastfeeding
infants showed high levels of protection

10. Breakthroughs in PrEP

11. PrEP and My Patients
clinicaloptions.com/hiv
iPrEx: Eligibility
 Male sex at birth (N = 2499)
 18 yrs of age or older
 HIV-seronegative status
 Evidence of risk for acquisition of HIV infection
Grant RM, et al. N Engl J Med. 2010;363:2587-2599.

12. PrEP and My Patients
clinicaloptions.com/hiv
iPrEX Study Sites
Sites 11
Participants 2499
San Francisco
9% Boston
Chiang Mai
5%
Iquitos
12% Guayaquil
Sao Paulo
Lima
15%
56%
Rio de Janeiro Cape Town
4%
Grant R, et al. CROI 2011. Abstract 92.

13. PrEP and My Patients
clinicaloptions.com/hiv
iPrEx: Baseline Demographics
Characteristic, % Overall
(N = 2499)
Age
 Younger than 25 yrs 50
 25-39 yrs 40
 40 yrs or older 10
Race
 White 17
Black 9
 Asian 5
 Mixed/other 69
 Latino 72
Completed some college 43
Grant RM, et al. N Engl J Med. 2010;363:2587-2599.

14. PrEP and My Patients
clinicaloptions.com/hiv
iPrEx: Efficacy
 Efficacy through study end (mITT): 42% (95% CI: 18% to 60%)
0.12
Placebo
FTC/TDF
Cumulative Probability
0.10
of HIV Infection
0.08
0.06
P = .002
0.04
0.02
0
0 12 24 36 48 60 72 84 96 108 120 132 144
Wks Since Randomization
Pts at Risk, n
Placebo 1248 1198 1157 1119 1030 932 786 638 528 433 344 239 106
FTC/TDF 1251 1190 1149 1109 1034 939 808 651 523 419 345 253 116
Grant R, et al. CROI 2011. Abstract 92.

15. Challenges of PrEP

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