18 May 2012

On May 10, 2012 a landmark recommendation was made by a US Food and Drug Administration (FDA) Advisory Committee in support of use of the combination antiretroviral drug, TRUVADA, as a prevention tool against HIV-infection. If this recommendation is accepted by the FDA on June 15, it could pave the way for widespread implementation of pre-exposure prophylaxis (PrEP) in communities at risk of HIV infection.

In this week’s issue of the prestigious science journal, The Lancet, Professors Salim and Quarraisha Abdool Karim provide their opinion about the significance of this milestone for the South African epidemic and why South Africa cannot afford not to provide PrEP

This development has great significance in the southern African context, where young women bear a disproportionate burden of the HIV epidemic. The incidence of HIV-infection in young women in rural South Africa increases dramatically from adolescence to young adulthood. In much of this region, young women are often unable to convince their male partners to use condoms, remain faithful, or have an HIV test, thereby disempowering young women and undermining their efforts to control their risk of HIV.

PrEP should not be regarded as the silver bullet against HIV-infection. Rather, its availability would provide another vital option that should be used in conjunction with other technologies, such as condoms, to reduce HIV-infection.

Professor Salim Abdool Karim comments: “Research is needed to identify additional drugs, additional formulations – such as rings, gels, injectables - and alternative dosing strategies for PrEP to have an even bigger effect with greater safety, less risk of resistance, higher adherence, and greater efficacy.

“Once PrEP becomes part of the HIV armamentarium, research will probably see this prevention technique advance rapidly with new formulations, and improved efficacy and safety. The strongest impetus for further research and rapid innovation in PrEP would be demand from patients and field implementation experience.”

PrEP has, in conjunction with ART for prevention, created new-found optimism in HIV prevention and has increased options for HIV prevention, especially for specific high-risk populations.