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

Zhang, Lanxin; Iannuzzi, Sara; Chaturvedula, Ayyappa; Irungu, Elizabeth; Haberer, Jessica E.; Hendrix, Craig W.; von Kleist, Max

doi:10.1038/s41591-023-02615-x

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

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Iannuzzi, Sara
IMPRS for Biology and Computation (Anne-Dominique Gindrat), Dept. of Computational Molecular Biology (Head: Martin Vingron), Max Planck Institute for Molecular Genetics, Max Planck Society;
Project group 5 ‘Systems Medicine of Infectious Diseases’, Robert Koch Institute, Berlin, Germany ;

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Citation

Zhang, L., Iannuzzi, S., Chaturvedula, A., Irungu, E., Haberer, J. E., Hendrix, C. W., et al. (2023). Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women. Nature Medicine, 29(11), 2753-2762. doi:10.1038/s41591-023-02615-x.

Cite as: https://hdl.handle.net/21.11116/0000-000F-2C7D-5

Abstract

Most 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.