Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges

AIDS Patient Care STDS. 2014 Sep;28(9):462-74. doi: 10.1089/apc.2013.0302. Epub 2014 Jul 21.


Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Administration, Oral
  • Anti-HIV Agents / administration & dosage*
  • Family Characteristics
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • HIV Seronegativity*
  • HIV Seropositivity / drug therapy*
  • HIV Seropositivity / psychology
  • HIV Seropositivity / transmission
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Primary Prevention / methods*
  • Sexual Partners / psychology
  • United States


  • Anti-HIV Agents