Greater adherence was associated with greater efficacy (RR with adherence ≥70%, 0.27 I 2 = 0%) in 6 trials. PrEP was associated with decreased risk of HIV infection vs placebo or no PrEP after 4 months to 4 years (11 trials relative risk, 0.46 I 2 = 67% absolute risk reduction, −2.0% ). Results Fourteen RCTs (N = 18 837), 8 observational studies (N = 3884), and 7 studies of diagnostic accuracy (N = 32 279) were included. Main Outcomes and Measures HIV acquisition, mortality, and harms adherence to PrEP and diagnostic test accuracy and discrimination. Data were pooled using the Dersimonian and Laird random-effects model for effects of PrEP on HIV infection, mortality, and harms. Study Selection English-language placebo-controlled randomized clinical trials of oral PrEP with tenofovir disoproxil fumarate/emtricitabine or tenofovir disoproxil fumarate monotherapy studies on the diagnostic accuracy of instruments for predicting incident HIV infection and studies on PrEP adherence.ĭata Extraction and Synthesis Dual review of titles and abstracts, full-text articles, study quality, and data abstraction. Objective To synthesize the evidence on the benefits and harms of PrEP, instruments for predicting incident HIV infection, and PrEP adherence to inform the US Preventive Services Task Force.ĭata Sources Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and EMBASE through June 2018, with surveillance through January 2019. Preexposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) daily or before and after sex to decrease risk of acquiring HIV infection. Importance Effective prevention strategies for HIV infection are an important public health priority.
Spontaneous Abortion Stratified by Study Drug Meta-analysis-Fracture Stratified by Study DrugĮFigure 9. Meta-analysis-Gastrointestinal Adverse Events Stratified by Study DrugĮFigure 8. Meta-analysis-Renal Adverse Events Stratified by Study DrugĮFigure 7. Meta-analysis-Withdrawals Due to Adverse Events Stratified by Study DrugĮFigure 6. Meta-analysis-Serious Adverse Events Stratified by Study DrugĮFigure 5. Meta-analysis-Mortality Stratified by Study DrugĮFigure 4. Meta-regression-PrEP Efficacy versus AdherenceĮFigure 3. Association Between Adherence to PrEP and Effectiveness for Preventing HIV AcquisitionĮFigure 2. Diagnostic Accuracy of HIV Risk Assessment Tools-ResultsĮTable 10. Diagnostic Accuracy of HIV Risk Assessment Tools-Study CharacteristicsĮTable 9. Effect of PrEP versus Placebo on HIV Infection in Population SubgroupsĮTable 8. HIV Pre-Exposure Prophylaxis Randomized Clinical Trials-Additional Information on Adherence and SubgroupsĮTable 7. HIV Pre-Exposure Prophylaxis Randomized Clinical Trials-ResultsĮTable 6. HIV Pre-Exposure Prophylaxis Randomized Clinical Trials-Study CharacteristicsĮTable 5. HIV Pre-Exposure Prophylaxis Cohort Studies Quality AssessmentĮTable 4. Diagnostic Accuracy of HIV Risk Assessment Tools Quality AssessmentĮTable 3.
HIV Preexposure Prophylaxis Randomized Clinical Trials Quality AssessmentĮTable 2.