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Ayerdi Aguirrebengoa, M. Vera García, J.A. Portocarrero Nuñez, T. Puerta López, M. García Lotero, C. Escalante Garcia, M. Raposo Utrilla, V. Estrada Pérez, J. Del Romero Guerrero, C. Rodríguez Martín" "autores" => array:10 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Ayerdi Aguirrebengoa" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Vera García" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Portocarrero Nuñez" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Puerta López" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "García Lotero" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Escalante Garcia" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Raposo Utrilla" ] 7 => array:2 [ "nombre" => "V." "apellidos" => "Estrada Pérez" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Del Romero Guerrero" ] 9 => array:2 [ "nombre" => "C." 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "396" "paginaFinal" => "397" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Martín-Carbonero, M.L. Montes" "autores" => array:2 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Martín-Carbonero" "email" => array:1 [ 0 => "lmcarbonero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "Montes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de VIH, Servicio de Medicina Interna II, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Para cuándo la implantación de la profilaxis pre-exposición frente al VIH en España?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We are at a historic moment in the fight against the human immunodeficiency virus (HIV). Based on the high efficacy of antiretroviral therapy (ART) and preventive measures, the possibility of stop the pandemic caused by the virus has, in recent years, been considered. To this end, the Joint United Nations Programme on HIV and AIDS (UNAIDS) set the ambitious goal for 2020 known as 90–90–90: 90% of individuals infected by HIV should be diagnosed; 90% of diagnosed individuals should be undergoing treatment, and 90% of individuals undergoing treatment should have an undetectable viral load.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Modeling studies have suggested that achieving this objective before 2020 would result in controlling the pandemic by 2030, which, in the medium term, would have major healthcare and economic benefits. In its report, UNAIDS emphasized that although treatment for infected patients is fundamental, it is not the only necessary tool for ending the epidemic. Other preventive strategies are also needed, including pre-exposure prophylaxis (PrEP) in populations with a high risk of infection. The United States government very recently presented its own plan to end the AIDS epidemic.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> The objective is to decrease the number of new infections by 75% in the next 5 years and by 90% in the next 10. To achieve this and the 90–90–90 target, the US will focus on other prevention strategies, specifically PrEP in high-risk populations, including men who have sex with men (MSM) and who practice high-risk sexual relations.</p><p id="par0010" class="elsevierStylePara elsevierViewall">For individuals at high risk of HIV infection (more than 2 per 100 person-years), both the World Health Organization and the European AIDS Clinical Society (EACS) recommend the daily use (or on demand dosing) of tenofovir/emtricitabine to prevent infection by the virus.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3,4</span></a> In Spain, the use of tenofovir/emtricitabine has also been recommended by the AIDS Study Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) since July 2016.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> In January 2018, the Spanish National AIDS Plan published a consensus document on the indications and management of PrEP in Spain.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> They recommended using PrEP in MSM and female transsexuals who, in the past year, have met at least 2 of the following criteria: having more than 10 sexual partners, practicing unprotected anal sex, using drugs related to maintaining sexual relations, having been administered postexposure prophylaxis on several occasions and having at least one sexually transmitted bacterial infection.</p><p id="par0015" class="elsevierStylePara elsevierViewall">PrEP should be accompanied by a set of preventive measures to improve compliance and promote the adoption of less risky behaviors, as well as facilitate clinical follow-up for this population. In high-risk populations, these measures have been shown to be safe and effective in reducing the number of new infections by up to 85%.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to its high price, the cost-benefit of ART has been questioned. However, we need to consider that this strategy could provide significant savings in the long term for high-risk populations. PrEP can be used for short periods of greater risk, while ART is currently a lifelong therapy. There are a number of studies that have demonstrated that if PrEP is administered along with other preventive measures and in selected populations, these measures could be cost effective in the long term.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> These studies were conducted before the patent for tenofovir/emtricitabine expired. Currently, with the emergence of generic drugs, the price is falling.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly, we need to consider that PrEP constitutes one of the most effective preventive public health interventions. The number of patients who require treatment to prevent a new HIV infection is 13,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> which is lower than that observed with other well-adopted preventive measures, such as the use of statins for preventing cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this journal issue, Ayerdi-Aguirrebengoa et al. translate the potential benefit of PrEP in our environment<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> by showing that the implementation of PrEP in Spain is an urgent measure in certain environments. If the recommendations issued by GESIDA had been followed, 168 new cases of HIV infection diagnosed in a reference center for HIV and sexually transmitted infections (STIs) could have been prevented between 2014 and 2016, which represents 73.3% of infections diagnosed during the study. In 2017, 3381 new cases of HIV infection were diagnosed in Spain.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> Some 84.6% of the cases involved young men, and transmission involving MSM was the most common. It is precisely this population who would most benefit from preventive programs that include PrEP. In fact, the Spanish Ministry of Health in their annual report considered the MSM group (especially those 25–34 years of age) a priority for prevention programs. With such actions, at least half of the new cases diagnosed in 2017 could have been prevented. However, the delay in implementing the recommendations of the Spanish National AIDS Plan jeopardized hundreds of individuals.</p><p id="par0035" class="elsevierStylePara elsevierViewall">As stated by the authors, motivated individuals are buying this drug without indication or medical follow-up. We should not forget that the use of antiretroviral drugs can promote the onset of adverse effects that need to be controlled by expert physicians.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">13,14</span></a> This is also a group at risk for contracting other STIs. Clinics specialized in STIs and HIV can simultaneously control the use of PrEP and treat STIs, as well as implement risk prevention programs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In a country with universal healthcare access, such as Spain, we need to implement measures as soon as possible that halt the onset of new cases of HIV infection. We have a national plan and extensive scientific evidence. Now we only lack putting it into practice.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Carbonero L, Montes ML. ¿Para cuándo la implantación de la profilaxis pre-exposición frente al VIH en España? Rev Clin Esp. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.20.19.03.010">https://doi.org/10.1016/j.rce.20.19.03.010</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "ONUSIDA. 90–90–90 Un ambicioso objetivo de tratamiento para contribuir al fin de la epidemia de sida. 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