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1、www.aodhealth.org1Updateon Alcohol,OtherDrugs,andHealthJuly–August2013www.aodhealth.org2Studieson Interventions&Assessmentswww.aodhealth.org3DailyTenofovirPre-ExposureProphylaxisReducesHIVTransmissionamongPeoplewithInjectionDrugUseinDrugTreatmentChoopanya
2、K,etal.Lancet.2013;381(9883):2083–2090.SummarybyAlexanderY.Walley,MD,MSc4Objectives/MethodsPre-exposureprophylaxiswithtenofovir/emtricitabineortenofoviralonereducestheincidenceofHIVinfectionfromsexualtransmissionbyabouthalf,aslongasadherenceisadequate.Res
3、earchersconductedarandomized,placebo-controlledtrialofdailypre-exposureprophylaxiswithtenofoviramong2413peopleinBangkok,Thailandwhoinjecteddrugsinthepastyear.www.aodhealth.orgwww.aodhealth.org5Objectives/Methods(cont’d)Studysiteswere17drugtreatmentclinics
4、thatofferedapackageofHIVpreventioninterventionsanddirectlyobservedtherapy.Participantschosetoreceivemedicationviadailydirectlyobservedtherapyormonthlyvisitsandcouldswitchmonthly.www.aodhealth.org6ResultsAtthebeginningofthestudy,33%ofthesampleabusedmethamp
5、hetamine,22%abusedheroin,23%abusedmidazolam,and22%werereceivingmethadonemaintenancetreatment.Atthebeginningofthestudy,theplacebogroupreportedmoresexualintercourseintheprior12weeksamongmenwhohadsexwithmen(6%versus4%)andsexwithacasualpartner(40%versus36%).M
6、eanfollow-uptimewas4years.Meanadherencewas84%ofdays.Participantsreceiveddirectlyobservedtherapy87%ofthestudydays.www.aodhealth.org7Results(cont’d)Forty-fivepercentofparticipantsreportedatleastoneincidenceofinjectiondruguseduringfollow-up.Therewere17HIVser
7、oconversions(incidenceof0.35per100person-years)inthetenofovirgroupand35(0.68per100person-years)intheplacebogroup,a49%reductioninHIVincidence.HIVincidencedidnotdifferuntil36monthsoffollow-up.Nausea,vomiting(8%versus5%),andincreaseinALT(53%versus49%)weremor
8、ecommoninthetenofovirgroup.www.aodhealth.org8CommentsAsinprevioustrialsinsexualriskgroups,inthistrialamongpeoplewhoinjectdrugspre-exposureprophylaxiscutHIVtransmissioninhalf.Adherencewaskeyandlikelybolsteredbythestu
