PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV Acquisition
- 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 clinicaloptions.com/hiv About These Slides Our thanks to the presenters who gave permission to include their original data Users are encouraged to use these slides in their own noncommercial presentations, but we ask that content and attribution not be changed. Users are asked to honor this intent This abbreviated slideset was posted to SlideShare to publicize the availability of the full slideset. These slides may not be published or posted online without permission from CCO (email permissions@clinicaloptions.com) Disclaimer The materials published on the Clinical Care Options Web site reflect the views of the authors of the CCO material, not those of Clinical Care Options, LLC, the CME providers, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
- 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
- 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
- 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.
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