Stanley O Onyegbule, Maryam Habib, Rija Khalid, Jessie Tu, Deborah Yoong, Jaris Swidrovich, Wale Ajiboye, Patrick O'Byrne, Ameeta E Singh, Jean-Guy Baril, Tatiana Sotindjo, Mark W Hull, Darrell H S Tan
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引用次数: 0
Abstract
Background: We conducted a systematic review of clinical trials and cohort studies on HIV post-exposure prophylaxis (PEP) regimens to inform updated 2025 Canadian guidelines.
Methods: We searched Medline and Embase (July 2017-June 2024) for studies reporting on: HIV acquisition, PEP completion, adverse events (AEs) leading to discontinuation and/or moderate to severe adverse events. Two reviewers independently screened abstracts and publications and extracted data from eligible articles.
Results: Of 5226 abstracts screened, we retrieved 112 full-text articles and included 22. Median study size was 160 (range = 52-26 988) participants. Regimens included DTG + TDF/XTC (n = 4, 18%), EVG/c/TDF/FTC (n = 4, 18%), BIC/TAF/FTC (n = 4, 18%), RAL + TDF/FTC (n = 4, 18%), EVG/c/TAF/FTC (n = 3, 14%), RPV/TDF/FTC (n = 2, 9%), DOR/TDF/FTC (n = 2, 9%), MVC + TDF/FTC (n = 1, 5%), a wide variety of protease inhibitor-based regimens (n = 7, 32%) and novel combinations with the injectable fusion inhibitor albuvirtide (n = 1, 5%); a third of studies included three or more regimens (n = 8, 36%). Among studies examining PEP completion rates (n = 12, 55%), cumulative completion rate was 86.6% (7779/8983 PEP episodes) and appeared highest for RAL + TDF/FTC, BIC/FTC/TAF and DOR/TDF/3TC at 96.4%, 96.3% and 95.0%, respectively. PEP tolerability was good, with few discontinuations due to adverse events; where data were available, this was lowest for INSTI-based regimens at 0.5% (pooled across two studies) for RAL + TDF/FTC, 1.0% (1/99) for DTG + TDF/XTC, 1.8% (2/109) for BIC/TAF/FTC and zero with albuvirtide (0/198). HIV seroconversions were rare (n = 5/8134, 0.06%) and often related to premature PEP discontinuation or repeated exposures.
Conclusions: Multiple PEP regimens have been associated with high completion, good tolerability and rare seroconversion, supporting their inclusion in clinical guidelines.
期刊介绍：
Published on behalf of the British Pharmacological Society, the British Journal of Clinical Pharmacology features papers and reports on all aspects of drug action in humans: review articles, mini review articles, original papers, commentaries, editorials and letters. The Journal enjoys a wide readership, bridging the gap between the medical profession, clinical research and the pharmaceutical industry. It also publishes research on new methods, new drugs and new approaches to treatment. The Journal is recognised as one of the leading publications in its field. It is online only, publishes open access research through its OnlineOpen programme and is published monthly.
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