On-demand oral TDF/FTC for PrEP: is it an option? 4 speakers put forward their argument for (and perhaps against) on demand PrEP. On-demand PrEP is an attractive and cost saving was of delivering PrEP but has only a limited number of studies to demonstrate its efficacy.
The first speaker presented strong evidence that both daily and multiple non-daily oral TDF/FTC were highly protective against the rectal and vaginal acquisition of SHIV in macaques. Various pre and post dose models were examined with “double” pre and post event dosing showing increased efficacy.
A pharmacologist followed up with a presentation demonstrating pharmacokinetic data that TDF/FTC reaches mucosal sites quickly, at appropriate concentrations and with a long enough “residence” to cover residual virus.
Bob Grant spoke following this about clinical experience of non-daily PrEP. Worldwide. Various non-daily PrEP studies (e.g. Holland, Montreal) show a significant cost saving as well as high patient satisfaction and preference. However, data from HPTN 067 showed fewer sex events were covered by non-daily PrEP use when compared with daily PrEP use.
The final speaker elaborated on the HPTN067 study. Non-daily PrEP regimens in this study were found to me more appropriate in participants who could adhere, had fewer sexual exposures and who could plan for sex.