Allen, E., Gordon, A., Krakower, D., Hsu, K. Current Opinion in Pediatrics (2017), 29:000–000, doi:10.1097/MOP.0000000000000512.
This review described available evidence for the use of pre-exposure prophylaxis (PrEP) in the form of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) among adolescents (<18 years old) and young adults (15–25 years old). A trial in South Africa among young women was stopped early because plasma levels showed that fewer than one-third of participants used PrEP. Three other randomized controlled trials found no difference between young adults and older adults in PrEP effectiveness, although adherence was lower among the younger group. Several additional studies have also demonstrated lower adherence among adolescents and young adults in comparison to their older counterparts. Studies have also shown that adherence declines over time as the frequency of clinic visits diminishes. Reduced adherence was attributed to a combination of developmental, psychosocial, socioeconomic, and structural factors. Concerns about the safety of PrEP in younger patients include the impact of TDF on bone mineral density (BMD), which is important among youth who are still developing. However, studies also show that BMD impacts can be reversed in those under age 25. Studies on risk compensation have yielded mixed results, underscoring the importance of patient counseling, adherence, and services for sexually transmitted infections. The studies revealed an interest in PrEP across young population groups. Challenges for PrEP use include lack of provider experience, cost, and issues surrounding consent.