User:Bluedeck/workplace/prep

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暴露前预防（亦作PrEP，英语Pre-Exposure Prophylaxis），是未感染HIV/艾滋病的人群利用处方药物对感染进行预防的手段。这是一种高危未感染人群可以采用的疗法。

Currently, the only drug which any health organization recommends for PrEP is Truvada, which is the brand name of the Gilead Sciences drug combination of tenofovir/emtricitabine. The Centers for Disease Control says that "PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every 3 months."[1]

One of PrEP's active ingredients, tenofovir disoproxil (TDF), is a nucleotide analog reverse transcriptase inhibitor. TDF effectively blocks HIV from incorporating its genetic material into the host's genome, and thus prevents HIV infection. [2]

PrEP is intended for use with condoms, so that each method can compensate for essential or casual efficacy deficits of the other.[1][3] There are social groups which both support and oppose the use of PrEP.

医学用途

The clinical practice guideline for PrEP published by the Centers for Disease Control.

In the United States, federal guidelines recommend the use of PrEP for HIV negative people with the following characteristics:

  • in a serodiscordant sexual relationship, meaning that the HIV-negative person regularly has sex with an HIV positive person[1]
  • anyone who is not in a monogamous relationship with an HIV negative person, and who...
  • anyone who has injected illicit drugs in the past six months, shared recreational drug injection equipment with other drug users in the past six months, or who has been in treatment for injection drug use in the past six months[1]

禁忌指征

Reasons for not using PrEP include the following:

  • Persons with HIV should never use PrEP, and an HIV test is necessary before starting to use PrEP[4]
  • Persons with kidney problems, especially decreased renal functions, have increased safety problems with using PrEP[4]
  • Persons with hepatitis B have increased safety problems with using PrEP[4]
  • Women who are pregnant or breastfeeding should speak with their doctors about potential risk to their children[4]
  • Minors may not have access to services which complement the effective use of PrEP, and need extra attention from their doctor if they use PrEP[4]

副作用

The PrEP studies have shown the drugs to be safe, with few side effects. Generally, minor side effects such as nausea or diarrhea resolve themselves within the first few months.[5] Any deleterious effect of Truvada on kidney function usually reverses with drug discontinuation,[6] but irreversible kidney damage can rarely occur.[來源請求]

历史

The terms "pre-exposure prophylaxis" and "PrEP" most commonly refer to an HIV-prevention strategy where antiretrovirals are used to protect HIV-negative people from HIV infection. The HIV antiviral Truvada was approved by the FDA for PrEP on 16 July 2012.[7] The CDC amended its guidelines for HIV prevention recommending pre-exposure prophylaxis with Truvada to high infection risk populations on 14 May 2014,[8] due to research indicating prophylactic effectivity preventing transmission from mother to child.[9] Prior to that date, Truvada was only approved to treat existing HIV infections.

PrEP has been gaining a lot of attention and focus, especially within the battle against AIDS in New York City, a metropolis known for the epidemic's fatality. Governor Andrew Cuomo of New York has pledged his battle to end AIDS by 2020. According to a New York Times article, Cuomo intends to dramatically drop the infection number to 750 by 2020 from about 3000 in 2013 and 14,000 in 1993. In a city that has a large gay population, Cuomo intends to target his gay male audience. In addition to the use of condoms, Cuomo hopes that PrEP will continue to reduce the number of infections. However, the drug has met some sort of resistance as users may be noted as "Truvada whores," or people who feel enabled to be more promiscuous and less safe in their sex practices due to a perceived heightened sense of security from H.I.V. infection because of the drug. Overall, the fight against HIV infection seems to be going strong. Infection rates have fallen 28% overall from 2007 to 2012.[10]

In July 2014 the World Health Organization issued guidelines saying it "strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection." [11]

参考

  1. ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Centers for Disease Control and Prevention. CDC - Pre-Exposure Prophylaxis (PrEP). Centers for Disease Control and Prevention. 30 September 2014 [28 December 2014]. 
  2. ^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139281/?report=printable#ref13
  3. ^ Gilead Sciences. Important Safety Information About TRUVADA for PrEP. Gilead Sciences. [12 July 2015]. 
  4. ^ 4.0 4.1 4.2 4.3 4.4 United States Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2014 (PDF). Centers for Disease Control and Prevention. 
  5. ^ 引证错误：没有为名为CL_Celum_2011_Topics的参考文献提供内容
  6. ^ http://www.aidsmap.com/iTruvadai-PrEP-does-not-harm-the-kidneys-trial-shows/page/2827796/
  7. ^ FDA approves first drug for reducing the risk of sexually acquired HIV infection (新闻稿). Food and Drug Administration. [28 February 2015]. 
  8. ^ CDC - Pre-Exposure Prophylaxis (PrEP) - Research - Prevention Research - HIV/AIDS. Centers for Disease Control and Prevention. [28 February 2015]. 
  9. ^ Celum C, Baeten JM. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence. Current Opinion in Infectious Diseases. February 2012, 25 (1): 51–7. PMC 3266126 可免费查阅. PMID 22156901. doi:10.1097/QCO.0b013e32834ef5ef. 
  10. ^ Barro, Josh. Pill to Prevent H.I.V. Gets a Prominent Backer: Andrew Cuomo. The New York Times. 3 July 2014 [30 November 2014]. 
  11. ^ Hellmann, Melissa. WHO Says All Men Who Have Sex With Men Should Take Antiretroviral Drugs. Time. 11 July 2014 [20 June 2015]. 

外部链接

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