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Tratamiento profiláctico preexposición para VIH-1. Eficacia, seguridad y adherencia. Revisión sistemática

Abstract:

Background: In Ecuador, until 2017, 35,544 people live with HIV, turning it into a concentrated epidemic, which is why a prevention strategy for to avoid seroconversion becomes a public health priority. Objective: Synthesize the scientific evidence on the efficacy, adherence, and adverse effects of pre-exposure prophylaxis for HIV in risk groups. Methods: Qualitative systematic review without meta-analysis. We looked up for scientific articles published in indexed journals obtained from electronic databases such as: PubMed, Cochrane, Epistemonikos, UpToDate, AVAC and Scopus. The selected articles met the established inclusion and exclusion criteria. Results: A total of 11 trials were included, most of them double-blind, randomized. These trials obtained a high quality of evidence with low risk of bias. PrEP was associated with a decrease in HIV infection compared to placebo in 6 of 11 studies. Combination therapy with TDF/FTC was concluded to be more effective than monotherapy in 2 of 11 studies. Injectable cabotegravir was shown to be more effective than placebo and conventional oral therapy in 3 of 11 studies. It was also shown that daily oral therapy has better adherence than those that are on demand. Most of the adverse effects reported were category 1 or 2 and none were cause of discontinuation of therapy. Conclusions: In the population at risk for HIV infection, PrEP with long-acting injectable cabotegravir demonstrated greater efficacy than conventional therapy with TDF/FTC. It was also shown that efficacy goes hand in hand with adherence, since studies with better adherence reports lower seroconversion rates. The adverse effects recorded in all the studies were mostly grade 1 and grade 2 according to the DAIDS scale; the most frequent adverse events were gastrointestinal and in those who used injectable prophylaxis, it was discomfort at the injection site.