by Bisrat K. Abraham and Roy Gulick
Purpose of review
Clinical trials of oral preexposure prophylaxis (PrEP) have focused on regimens of tenofovir (TDF) with or
without emtricitabine (FTC). However, TDF may be associated with toxicities (renal, bone), and FTC may
select for drug resistance. Both are also first-line drugs for HIV treatment. In this review, we discuss agents
that might serve as alternatives to TDF/FTC for HIV PrEP.
Recent findings
Several drug characteristics are important to consider when selecting agents for PrEP with the most critical
being safety, tolerability, adequate penetration into target tissues for prevention of HIV infection, and longlasting
activity with convenient dosing. With these factors in mind, we review five potentially useful agents
for PrEP. The first group includes drugs that are already Food and Drug Administration approved
(maraviroc, raltegravir) with attributes that make them attractive for PrEP. The second group includes
investigational agents with long-lasting activity that are being developed in parenteral form (rilpivirine-long
acting, S/GSK1265744, ibalizumab).
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Summary
Future PrEP drugs may give clinicians the flexibility to select agents on the basis of individual patient needs
and preferences