Preexposure prophylaxis for the prevention of HIV transmission to women

The Food and Drug Administration (FDA) recently approved a new preexposure prophylaxis (PrEP) indication for emtricitabine/tenofovir for men and women, allowing a new effective HIV prevention intervention. Recent clinical trials have demonstrated the efficacy of PrEP in reducing the risk of HIV acquisition among women. Its efficacy depends largely on adherence. Perception of HIV risk appears to drive adherence to PrEP. What motivates PrEP use is specific to the population and its unique vulnerabilities. Future interventions exploring the efficacy of PrEP must include a behavioral arm that is specific to the unique vulnerabilities of the population being studied. There are an estimated 140 000 heterosexual serodiscordant couples in the United States; approximately, half of these couples desire conception. HIV-uninfected women in serodiscordant couples seeking conception may prove to be an ideal population for PrEP. Periconceptional PrEP in highly motivated couples could be not only effective but also affordable and feasible. In order to make PrEP accessible to those populations most vulnerable to HIV infection, the following steps need to occur: PrEP needs to be affordable, particularly for those uninsured; HIV providers, primary care practitioners, and reproductive healthcare providers need to welcome PrEP as a component of their scope of practice; clinicians need to take adequate sexual histories of all their patients in order to identify those at risk and best candidates for PrEP; and identifying ways to promote adherence must include population-specific PrEP adherence interventions. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins AIDS 2013, 27:F1-F5