Published online Sep 20, 2017.
https://doi.org/10.3947/ic.2017.49.3.243
Summary of Guidelines for the Use of Pre-Exposure Prophylaxis for HIV in Korea
Abstract
There are several guidelines for the use of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) which are used in other countries. However, the implementation of such guidelines in each country should be modified according to the country's clinical and epidemiological situation. Therefore, The Korean Society for AIDS founded a committee in 2016 to develop guidelines for the use of PrEP for HIV that are optimal for Korea's clinical and epidemiological situation. These guidelines aim to provide comprehensive information for PrEP implementation in Korea. The recommendations contain important information for physicians working to prevent HIV infection in actual clinical fields. The committee will regularly review and revise the guidelines based on changes in PrEP administration and HIV prevention practices.
Rating scheme for recommendations
Recommendations in these guidelines are based upon scientific evidence and expert opinion. Table 1 shows the rating scheme according to the strength of the recommendation and the quality of the evidence [1].
Table 1
Strength of recommendation and quality of evidence for recommendation
Key evidences
The preexposure prophylaxis initiative (iPrEx) study was a randomized, double-blind, placebo-controlled trial conducted among men and male-to-female transgender adults who reported having sexual intercourse with a same sex partner during the 6 months preceding enrollment [2]. Participants were randomly assigned to receive a daily oral dose of either the fixed-dose combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) or a placebo. Enrollment in the TDF/FTC group was associated with a 44% reduction in the risk of HIV acquisition (95% confidence interval [CI], 15-63).
The Partners PrEP trial was a randomized, double-blind, placebo-controlled study of daily oral TDF/FTC or TDF for the prevention of acquisition of HIV by the uninfected partner in 4,758 HIV-serodiscordant heterosexual couples in Uganda and Kenya [3]. The trial was stopped after an interim analysis in mid-2011 showed statistically significant efficacy in the medication groups (TDF/FTC or TDF) compared with the placebo group.
The Bangkok tenofovir study was a randomized, double-blind, placebo-controlled study that assessed the safety and efficacy of daily oral TDF for HIV prevention among 2,413 injection drug users (IDUs) in Bangkok, Thailand [4]. In the modified intent-to-treat analysis (excluding 2 participants with evidence of HIV infection at enrollment), efficacy of TDF was 48.9% (95% CI, 9.6-72.2; P = 0.01).
Recommendations
1) Indication of PrEP for HIV prevention in Korea
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2) Preferred antiretroviral regimen for HIV PrEP
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3) Dosing recommendation for HIV PrEP
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4) Assessment and testing before initiation of PrEP
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5) Clinical follow up and monitoring during PrEP (Table 2)
Table 2
Clinical follow-up and monitoring for HIV-uninfected person taking PrEP
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6) Education for persons taking PrEP
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Supplementary material
Guideline Korean version.
Supplementary material can be found with this article online http://www.icjournal.org/src/sm/ic-
Supplementary
Click here to view.(465K, pdf)
The Committee for Guidelines for the use of pre-exposure prophylaxis for HIV of The Korean Society for AIDS.
Chairman:Jun Yong Choi (Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea)
Member of the Committee:Member of the Committee: Shin-Woo Kim (Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea), Tae Hyong Kim (Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea), Ji Hwan Bang (Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea), Joon Young Song (Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea), Bum Sik Chin (Department of Internal Medicine, National Medical Center, Seoul, Korea), Youn Jeong Kim (Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea)
The following recommendations are a set of practical guidelines based on the current (August 2017) domestic Korean status. Rather than applying the following principles to the general public, we recommended that the pre-exposure prophylaxis be based upon clinical decision making according to the patient’s individual health history.
The following recommendations can be used for educational and personal clinical practices, but cannot be utilized for any commercial or clinical evaluation purposes. Those who wish to use the following guidelines for purposes other than educational or personal clinical practice must submit a written form and obtain written consent from the committee.
Conflict of Interest:No conflicts of interest.
References
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Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell JJ, Zheng JH, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV. iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010;363:2587–2599.
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