Where next with preexposure prophylaxis?
Controlling the HIV epidemic remains a major public health challenge, and there is an urgent need for novel prevention strategies. Preexposure prophylaxis (PrEP) refers to the use of antiretrovirals in HIV-negative people at high risk to prevent infection and has the potential to be an important component in the global effort to end the HIV epidemic by 2030. We review the current evidence for the safety and efficacy of PrEP in its different forms and address emergent issues and concerns regarding its implementation. Two further randomized control trials report high efficacy of both daily and intermittent PrEP in MSM leading to renewed calls for wider availability of PrEP for this group. Oral tenofovir disoproxil/emtricitabine has been licensed for PrEP in many countries and is well tolerated, safe and effective. Oral PrEP is well tolerated and effective in reducing the incidence of HIV infection in individuals at high risk. Implementation in high-income countries is progressing slowly; demonstration projects and trials continue in low and middle-income countries.