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PrEP in 2011: Results from the iPrEx Study and Discussion of the Public Health Implications
Slide Presentation
January 20, 2010
Robert M. Grant, MD, MPH
Grant Colfax, MD

Click on slide thumbnails to view full-size image.

Slide 1.
A Pill a Day To Keep HIV Away
Slide 1.
The HIV Pandemic
Slide 2.
HIV Prevention Methods with Demonstrated Efficacy in MSM
Slide 3.
MSM Have 19.3 Higher Odds of HIV Infection
Slide 4.
Why Tenofovir and/or Emtricitabine?
Slide 5.
Monkey Studies at CDC Repeated Rectal SHIV Exposure
Slide 6.
PrEP Initiative/Inciativa PrEx
Slide 7.
The iPrEx Study
Slide 8.
Participants: 2,499
Slide 9.
4,905 Screened
Slide 10.
Infections at Enrollment
Slide 11.
Baseline Characteristics of the Participants, According to Study Group
Slide 12.
Efficacy (MITT) 44% (15-63%) Infection Numbers: 64 - 36 = 28 averted
Slide 13.
Summary: Efficacy of Oral FTC/TDF PrEP
Slide 14.
Sampling for Case Control Study
Slide 15.
Drug Detection is Highly Concordant
Slide 16.
Drug Detection by HIV Status in the FTC/TDF Group
Slide 17.
Drug Detection by HIV Status by Unprotected Receptive Anal Intercourse (URAI)
Slide 18.
Drug Level and Decreased HIV Risk Ratio
Slide 19.
Drug Levels
Slide 20.
Plasma HIV Level
Slide 21.
Drug Resistance
Slide 22.
Adverse Events
Slide 23.
Adverse Events
Slide 24.
Sexual Partners
Slide 25.
Condom Use with High Risk Sex
Slide 26.
Conclusions: Efficacy
Slide 27.
Conclusions: Safety
Slide 28.
Open Label Extension
Slide 29.
Premise
Slide 30.
Factors Favoring Cost Effective Implementation
Slide 31.
Factors not Favoring Cost Effectiveness
Slide 32.
Acknowledgments
Slide 33.
iPrEx
Slide 34.
After iPrEx: Implications for Public Health in San Francisco
Slide 35.
Given Efficacy, What is Potential PrEP Effectiveness?
Slide 36.
Ethical Allocation of Preexposure HIV Prophylaxis
Slide 37.
iPrEx: Number Needed to Treat Compared with Other Health Interventions
Slide 38.
SF: An Ideal Setting for PrEP Roll-out
Slide 39.
Lessons Learned from PEP
Slide 40.
A Framework for PrEP Implementation
Slide 41.
SF PrEP Demonstration Project
Slide 42.
Combination Prevention
Slide 43.
How Many MSM Would Qualify for PrEP in SF?
Slide 44.
Awareness of iPrEx PrEP Results
Slide 45.
Willingness to Use PrEP
Slide 46.
Potential for Risk Compensation or Behavioral Disinhibition
Slide 47.
Potential Increases in Risk Behavior and Change in Cumulative Infections as a Function of PrEP Effectiveness
Slide 48.
Theoretical Concerns about Behavior Should Not Preclude PrEP Demonstration Projects...
Slide 49.
PrEP Demonstration Project:Challenges
Slide 50.
Modeling the Impact of HIV Chemoprophylaxis Strategies among Men Who Have Sex with Men in the United States: HIV Infections Prevented and Cost-effectiveness
Slide 51.
SFDPH Comprehensive System of HIV Prevention and Care
Slide 51.
Acknowledgments
Slide 51.

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