Comparative benefits of pre-exposure prophylaxis versus test-and-treat to reduce community viral load: a systematic review of PrEP Trials.

Published Date: 01st October 2025

Publication Authors: Garrat. A

Abstract: 

Purpose: There were 1.3 million new HIV acquisitions in 2023 and 28% of people living with HIV had not achieved viral suppression with potential to transmit HIV. Sustainable Development Goal 3.3 outlines a target to end the HIV epidemic by 2030. Lenacapavir is a new, injectable form of prevention treatment, or pre-exposure prophylaxis (PrEP), that has demonstrated 100% efficacy in initial trials. However, recent cuts to US funding mean identification and prioritisation of effective methods to reduce HIV transmission are vital. An analysis of PrEP trials was performed to determine prevalence and incidence of HIV in different populations, in order to compare a Test-and-treat approach against Lenacapavir as PrEP for HIV transmission.
Method(s): A systematic search for randomised, controlled trials of PrEP was performed until 13th March 2025 in MEDLINE, EMBASE and GLOBAL HEALTH databases via Ovid. The search terms 'PrEP', 'HIV' and 'efficacy' were used. Baseline characteristics of the trials were extracted, with the primary outcome being ratio of prevalence:incidence of HIV in each trial. Analysis was stratified by risk populations.
Result(s): 3433 records were retrieved and 19 trials with 36,266 participants in treatment and control arms were included in the final analysis. The mean ratio of prevalence:incidence across the trials was 3.8 (range 0.1 - 16.0). 3.8 people living with HIV could be diagnosed and linked-to-care for treatment, for every HIV acquisition that could be prevented with Lenacapavir.
Conclusion(s): In this analysis of 19 RCTs of PrEP, the benefits of Test-and-treat at the screening stage are greater than the benefits of administering 100% effective PrEP. Screening and early initiation of ART in Testand- treat approaches remains critical in prevention of HIV transmission. Long-acting PrEP prices must be brought down in order to be cost-effective.

Muraleetharan, A.; Garratt, A.; Et al. (2025). Comparative benefits of pre-exposure prophylaxis versus test-and-treat to reduce community viral load: a systematic review of PrEP Trials. HIV Medicine. 26(Supp 4), pp.198-199. [Online]. Available at: https://dx.doi.org/10.1111/hiv.70104 [Accessed 20 November 2025].