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Invited Commentary
February 2015

Preexposure Prophylaxis: A Path Forward

Author Affiliations
  • 1Department of Health Services, Los Angeles County, Los Angeles, California
  • 2Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. 2015;175(2):255-256. doi:10.1001/jamainternmed.2014.6798

Thirty years after the discovery of the human immunodeficiency virus (HIV), about 50 000 Americans and over 2 million persons worldwide are infected each year, most of them through sexual relations.1 This occurs despite detailed knowledge of how HIV is transmitted and the availability of a highly effective, cheap, safe method of HIV prevention, the condom, which in addition to its effectiveness in HIV prevention, also decreases the likelihood of other sexually transmitted diseases as well as unwanted pregnancies.

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    1 Comment for this article
    Innovative delivery systems for pre-exposure prophylaxis
    David L Keller, MD | none
    Pre-exposure prophylaxis (PEP) is a reasonable option when adherence to condom use is imperfect. In order to improve compliance with PEP by reducing pill burden, antiviral medication could be incorporated into oral contraceptive pills prescribed to seronegative female partners in HIV-discordant couples. In cases where the discordant seronegative partner is male, other means of reducing the pill count required to deliver PEP could be used. For example, a seronegative older man with erectile dysfunction who engages in risky behaviors could be prescribed a phosphodiesterase inhibitor pill (such as sildenafil) which also includes the recommended antiviral PEP medications.