Pre-exposure prophylaxis

Last updated

Pre-exposure prophylaxis (PrEP), is the use of medications to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent. Vaccination is the most commonly used form of pre-exposure prophylaxis; other forms of pre-exposure prophylaxis generally involve drug treatment, known as chemoprophylaxis. Examples include taking medication to prevent infection by malaria or HIV. In particular, the term PrEP is now synonymous in popular usage with the use of pre-exposure prophylaxis for HIV prevention.

Contents

In general, the use of pre-exposure prophylaxis requires balancing the risks of the treatment (e.g., side effects from a drug) to healthy individuals with the risk of the disease.

It should be contrasted with post-exposure prophylaxis, which is used once the patient has already been exposed to the infectious agent.

Use of pre-exposure medication against specific diseases

Malaria

The use of pre-exposure drug treatment to prevent malaria using antimalarial drugs is well-established, [1] with the use of quinine as a prophylactic treatment dating back at least to the 19th century.[ citation needed ]

HIV/AIDS

The abbreviation PrEP now typically refers to pre-exposure prophylaxis for HIV prevention, the use of antiviral drugs as a strategy for the prevention of HIV/AIDS. [2] PrEP is one of a number of HIV prevention strategies for people who are HIV negative but who have a higher risk of acquiring HIV, including sexually active adults at increased risk of contracting HIV, people who engage in intravenous drug use (see drug injection), and serodiscordant sexually active couples. [3]

When used as directed, PrEP has been shown to be highly effective at preventing HIV infection, reducing the risk of acquiring HIV by up to 99%. [4] A large-scale study in the UK has shown that PrEP remains effective at preventing HIV infection, even when used in uncontrolled environments. [5]

COVID-19

Pre-exposure prophylaxis against infection by SARS-CoV-2, the virus that causes COVID-19, has been studied as a possible preventive measure for high-risk groups. [6]

In December 2021, the US FDA granted emergency use authorization (EUA) of the antibody drug tixagevimab/cilgavimab (Evusheld) to prevent COVID-19 in immunocompromised people who cannot be fully vaccinated due to a history of a severe reaction to coronavirus vaccines. [7] [8] However, due to the high levels of non-susceptible SARS-CoV-2 variants present in the US, the FDA announced on 6 January 2023 that tixagevimab/cilgavimab was no longer currently authorized for emergency use in the US. [9]

In March 2024, pemivibart (Pemgarda), a monoclonal antibody drug, received an emergency use authorization from the US FDA to protect certain moderately to severely immunocompromised individuals against COVID-19. [10] [11]

Pre-exposure prophylaxis for post-mortems

Since conducting autopsies may involve inadvertent cuts, and the incidence of hepatitis-B can be very high in certain populations, it is advisable for all autopsy personnel to get their hepatitis-B antibody status tested. If antibodies are not present in sufficient concentration, hepatitis-B vaccine must be taken. [12]

Related Research Articles

Men who have sex with men (MSM) are men who engage in sexual activity with other men, regardless of their sexual orientation or sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay, bisexual, pansexual or various other sexualities, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. The alternative term "males who have sex with males" is sometimes considered more accurate in cases where those described may not be legal adults.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

<span class="mw-page-title-main">Tenofovir disoproxil</span> Antiviral drug used to treat or prevent HIV and hepatitis infections

Tenofovir disoproxil, sold under the brand name Viread among others, is a medication used to treat chronic hepatitis B and to prevent and treat HIV/AIDS. It is generally recommended for use with other antiretrovirals. It may be used for prevention of HIV/AIDS among those at high risk before exposure, and after a needlestick injury or other potential exposure. It is sold both by itself and together in combinations such as emtricitabine/tenofovir, efavirenz/emtricitabine/tenofovir, and elvitegravir/cobicistat/emtricitabine/tenofovir. It does not cure HIV/AIDS or hepatitis B. It is available by mouth as a tablet or powder.

<span class="mw-page-title-main">Needlestick injury</span> Accidental puncture of skin causing contamination

A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). In healthcare and laboratory settings globally, there are over 25 distinct types of blood-borne diseases that can potentially be transmitted through needlestick injuries to workers. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.

<span class="mw-page-title-main">Emtricitabine/tenofovir</span> Drug combination for HIV/AIDS prophylaxis and treatment

Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoproxil. For treatment, it must be used in combination with other antiretroviral medications. For prevention before exposure, in those who are at high risk, it is recommended along with safer sex practices. It does not cure HIV/AIDS. Emtricitabine/tenofovir is taken by mouth.

<span class="mw-page-title-main">Pre-exposure prophylaxis for HIV prevention</span> HIV prevention strategy using preventative medication for HIV-negative individuals

Pre-exposure prophylaxis for HIV prevention, commonly known as PrEP, is the use of antiviral drugs as a strategy for the prevention of HIV/AIDS by people that do not yet have HIV/AIDS. PrEP is one of a number of HIV prevention strategies for people who are HIV negative but who have a higher risk of acquiring HIV, including sexually active adults who are at increased risk of contracting HIV, people who engage in intravenous drug use, and serodiscordant sexually active couples.

<span class="mw-page-title-main">HIV Prevention Trials Network</span>

The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that brings together investigators, ethicists, community and other partners to develop and test the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. HPTN studies evaluate new HIV prevention interventions and strategies in populations and geographical regions that bear a disproportionate burden of infection. The HPTN is committed to the highest ethical standards for its clinical trials and recognizes the importance of community engagement in all phases of the research process.

<span class="mw-page-title-main">Hepatitis B vaccine</span> Vaccine against hepatitis B

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.

iPrEx

iPrEx was a phase III clinical trial to determine whether the antiretroviral medication emtricitabine/tenofovir could safely and effectively prevent HIV acquisition through sex in men who have sex with men and transgender women. iPrEx was the first human study of an HIV prevention strategy known as pre-exposure prophylaxis, or PrEP.

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

In January 2018, the provincial government of British Columbia (BC) began providing individuals at high risk of HIV infection with pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at no cost. High risk individuals include men and trans women who have sex with men, people who inject drugs, and people who have sex with people living with HIV. One year following this policy change, which is delivered as part of the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE)'s Drug Treatment Program, almost 3,300 people have been prescribed with PrEP or PEP.

Julia Lenore Marcus is an American public health researcher and infectious disease epidemiologist at Harvard Medical School. Her research focuses on improving the implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Marcus is also a popular science communicator, and has contributed to The Atlantic.

Bamlanivimab/etesevimab is a combination of two monoclonal antibodies, bamlanivimab and etesevimab, administered together via intravenous infusion as a treatment for COVID-19. Both types of antibody target the surface spike protein of SARS‑CoV‑2.

<span class="mw-page-title-main">Chloroquine and hydroxychloroquine during the COVID-19 pandemic</span> Early experimental treatment efforts during the start of COVID-19 pandemic

Chloroquine and hydroxychloroquine are anti-malarial medications also used against some auto-immune diseases. Chloroquine, along with hydroxychloroquine, was an early experimental treatment for COVID-19. Neither drug has been useful to prevent or treat SARS-CoV-2 infection. Administration of chloroquine or hydroxychloroquine to COVID-19 patients, either as monotherapies or in conjunction with azithromycin, has been associated with deleterious outcomes, such as QT prolongation. As of 2024, scientific evidence does not substantiate the efficacy of hydroxychloroquine, with or without the addition of azithromycin, in the therapeutic management of COVID-19.

<span class="mw-page-title-main">Lenacapavir</span> Antiretroviral medication

Lenacapavir, sold under the brand name Sunlenca, is an antiretroviral medication used to treat HIV/AIDS. It is taken by mouth or by subcutaneous injection.

<span class="mw-page-title-main">Tixagevimab/cilgavimab</span> Monoclonal antibody treatment for COVID-19

Tixagevimab/cilgavimab, sold under the brand name Evusheld, is a combination of two human monoclonal antibodies, tixagevimab (AZD8895) and cilgavimab (AZD1061) targeted against the surface spike protein of SARS-CoV-2 used to prevent COVID-19. It is being developed by British-Swedish multinational pharmaceutical and biotechnology company AstraZeneca. It is co-packaged and given as two separate consecutive intramuscular injections.

<span class="mw-page-title-main">David Boulware</span>

David Boulware is a professor of medicine and a practicing infectious disease physician at the University of Minnesota Medical School. He is a member of the graduate faculty for the University of Minnesota School of Public Health Epidemiology PhD program and for the Microbiology, Immunology, and Cancer Biology (MICaB) graduate program. Boulware was the first Lois & Richard King Distinguished Assistant Professorship at the University of Minnesota. Boulware is an active medical researcher engaged in clinical trials in infectious diseases. His expertise is particularly in the realm of HIV-related meningitis, including Cryptococcosis and Tuberculous meningitis.

Pemivibart, sold under the brand name Pemgarda, is a monoclonal antibody medication authorized for the pre-exposure prophylaxis (prevention) of COVID‑19. Pemivibart was developed by Invivyd.

References

  1. ↑ "Malaria | CDC Yellow Book 2024". wwwnc.cdc.gov. Retrieved 2023-11-30.
  2. ↑ "Pre-Exposure Prophylaxis". HIV.gov. 2019-12-03. Retrieved 2020-08-03.
  3. ↑ US Public Health Service. "Preexposure prophylaxis for the prevention of HIV infection in the United States - 2014" (PDF). Centers for Disease Control and Prevention (CDC). Archived from the original (PDF) on 11 April 2018. Retrieved 15 December 2017.
  4. ↑ "Effectiveness of Prevention Strategies to Reduce the Risk of Acquiring or Transmitting HIV". Centers for Disease Control and Prevention (CDC). 2019-11-12. Archived from the original on 10 December 2019. Retrieved 9 December 2019.
  5. ↑ Sullivan, Ann K; Saunders, John; Desai, Monica; Cartier, Andrea; Mitchell, Holly D; Jaffer, Sajjida; Ogaz, Dana; Chiavenna, Chiara; Charlett, Andre; Diamente, Victor; Golombek, Rainer; Manavi, Kaveh; Priestley, Cecilia; Waters, Laura J; Milinkovic, Ana (December 2023). "HIV pre-exposure prophylaxis and its implementation in the PrEP Impact Trial in England: a pragmatic health technology assessment". The Lancet HIV. 10 (12): e790–e806. doi:10.1016/s2352-3018(23)00256-4. ISSN   2352-3018. PMID   38040478.
  6. ↑ "Pre-exposure prophylaxis (PrEP) and COVID-19: independent advisory group report". GOV.UK. Retrieved 2023-11-30.
  7. ↑ "Evusheld- azd7442 kit". DailyMed . AstraZeneca. 20 December 2021. Archived from the original on 5 January 2022. Retrieved 20 January 2022.
  8. ↑ Mishra M, Satija B (8 December 2021). Dasgupta S (ed.). "U.S. FDA authorizes use of AstraZeneca COVID-19 antibody cocktail". Reuters . Archived from the original on 13 January 2022. Retrieved 18 January 2022.
  9. ↑ "Latest FDA Updates for Evusheld". U.S. Food and Drug Administration. 6 January 2023. Retrieved 8 April 2024.
  10. ↑ MacMillan, Carrie (5 April 2024). "FDA Authorizes COVID Drug Pemgarda for High-Risk Patients". Yale Medicine. Retrieved 8 April 2024.
  11. ↑ Cavazzoni, Patrizia (3 April 2024). "EUA 122 Invivyd Pemgarda LOA". U.S. Food and Drug Administration. Archived from the original on 8 April 2024. Retrieved 8 April 2024.
  12. ↑ Gill JR (2016). "Autopsy: Infectious and Serious Communicable Diseases". Encyclopedia of Forensic and Legal Medicine: 279–284. doi: 10.1016/B978-0-12-800034-2.00039-2 . ISBN   978-0-12-800055-7. PMC   7149624 .
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.