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Tenofovir-Based Preexposure Prophylaxis for HIV Infection among African Women

Publication year: 
2015
Author (s): 
Marrazzo, Jeanne M. [et al.]
Publication details: 
USA, Massachusetts Medical Society, 2015
Publication in: 
N engl j med 372;6 nejm.org February 5, 2015
Abstract:

BACKGROUND
Reproductive-age women need effective interventions to prevent the acquisition of
human immunodeficiency virus type 1 (HIV-1) infection.

METHODS
We conducted a randomized, placebo-controlled trial to assess daily treatment with oral tenofovir disoproxil fumarate (TDF), oral tenofovir–emtricitabine (TDF-FTC), or 1% tenofovir (TFV) vaginal gel as preexposure prophylaxis against HIV-1 infection in women in South Africa, Uganda, and Zimbabwe. HIV-1 testing was performed monthly, and plasma TFV levels were assessed quarterly.

RESULTS
Of 12,320 women who were screened, 5029 were enrolled in the study. The rate of
retention in the study was 91% during 5509 person-years of follow-up. A total of 312 HIV-1 infections occurred; the incidence of HIV-1 infection was 5.7 per 100 person years. In the modified intention-to-treat analysis, the effectiveness was −49.0% with TDF (hazard ratio for infection, 1.49; 95% confidence interval [CI], 0.97 to 2.29), −4.4% with TDF-FTC (hazard ratio, 1.04; 95% CI, 0.73 to 1.49), and 14.5% with TFV gel (hazard ratio, 0.85; 95% CI, 0.61 to 1.21). In a random sample, TFV was detected in 30%, 29%, and 25% of available plasma samples from participants randomly assigned to receive TDF, TDF-FTC, and TFV gel, respectively. Independent predictors of TFV detection included being married, being older than 25 years of age, and being multiparous. Detection of TFV in plasma was negatively associated with characteristics predictive of HIV-1 acquisition. Elevations of serum creatinine levels were seen more frequently among participants randomly assigned to receive oral TDF-FTC than among those assigned to receive oral placebo (1.3% vs. 0.2%, P = 0.004). We observed no significant differences in the frequencies of other adverse events.

CONCLUSIONS
None of the drug regimens we evaluated reduced the rates of HIV-1 acquisition in
an intention-to-treat analysis. Adherence to study drugs was low. (Funded by the
National Institutes of Health; VOICE ClinicalTrials.gov number, NCT00705679.