Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women

dc.creatorZhang, Lanxin
dc.creatorIannuzzi, Sara
dc.creatorChaturvedula, Ayyappa
dc.creatorIrungu, Elizabeth
dc.creatorHaberer, Jessica E.
dc.creatorHendrix, Craig W.
dc.creatorvon Kleist, Max
dc.date.accessioned2023-12-01T20:27:50Z
dc.date.available2023-12-01T20:27:50Z
dc.date.issued2023-11-14
dc.description.abstractMost human immunodeficiency virus (HIV) infections occur in cisgender women in resource-limited settings. In women, self-protection with emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis (FTC/TDF-PrEP) constitutes a major pillar of HIV prevention. However, clinical trials in women had inconsistent outcomes, sparking uncertainty about adherence requirements and reluctance in evaluating on-demand regimens. We analyzed data from published FTC/TDF-PrEP trials to establish efficacy ranges in cisgender women. In a 'bottom-up' approach, we modeled hypotheses in the context of risk-group-specific, adherence-efficacy profiles and challenged those hypotheses with clinical data. We found that different clinical outcomes were related to the proportion of women taking the product, allowing coherent interpretation of the data. Our analysis showed that 90% protection was achieved when women took some product. We found that hypotheses of putative male/female differences were either not impactful or statistically inconsistent with clinical data. We propose that differing clinical outcomes could arise from pill-taking behavior rather than biological factors driving specific adherence requirements in cisgender women.
dc.description.sponsorshipOpen access funding provided by Robert Koch-Institut.
dc.identifier.citationZhang, L., Iannuzzi, S., Chaturvedula, A., Irungu, E., Haberer, J. E., Hendrix, C. W., & von Kleist, M. (2023). Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women. Nature medicine, 29(11), 2753-2762. https://doi.org/10.1038/s41591-023-02615-x
dc.identifier.issn1546-170X
dc.identifier.issue11
dc.identifier.urihttps://hdl.handle.net/20.500.12503/32443
dc.identifier.volume29
dc.publisherSpringer Nature
dc.relation.urihttps://doi.org/10.1038/s41591-023-02615-x
dc.rights.holder© The Author(s) 2023
dc.rights.licenseAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceNature Medicine
dc.subject.meshAnti-HIV Agents / therapeutic use
dc.subject.meshPre-Exposure Prophylaxis
dc.subject.meshHIV Infections / drug therapy
dc.subject.meshHIV Infections / prevention & control
dc.titleModel-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women
dc.typeArticle
dc.type.materialtext

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