First case of E anophelis outbreak in an intensive-care unit

www.thelancet.com Vol 382 September 7, 2013 855 2 Grant RM, Lama JR, Anderson PL, et al, and the iPrEx Study Team. Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363: 2587–99. 3 Thigpen MC, Kebaabetswe PM, Paxton LA, et al, and the TDF2 Study Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012; 367: 423–34. 4 Baeten JM, Donnell D, Ndase P, et al, and the Partners PrEP Study Team. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367: 399–410. 5 Vanichseni S, Martin M, Suntharasamai P, et al. HIV-associated risk behavior among injecting drug users participating in an HIV preexposure prophylaxis trial in Bangkok, Thailand. IAS Conference on HIV Pathogenesis, Treatment and Prevention, Kuala Lumpur, Malaysia, July 2013 (abstract: MOLBPE27). among participants who became infected during follow-up. We agree with Andrew Craig and colleagues that individuals and policy makers will need to consider cost when deciding which HIV prevention method or combination of methods to use. We note that the incremental cost of providing preexposure prophylaxis in settings where HIV-prevention services are available would be relatively small, and targeting individuals at highest risk of HIV infection would decrease the cost per infection averted. Data from trials suggest that when pre-exposure prophylaxis is provided with a package of HIV prevention services, HIVassociated risk behavior will decrease rather than increase. Nonetheless, it will be important to monitor for risk compensation in future pre-exposure prophylaxis projects. Additional work is needed to establish how best to implement preexposure prophylaxis in conjunction with other proven prevention measures among people who inject drugs, including: how to support adherence, assessing the cost of pre-exposure prophylaxis, and determining appropriate venues for pre-exposure prophylaxis delivery. Nonetheless, for people who will not or cannot stop injecting drugs, preexposure prophylaxis might provide an important new HIV prevention method to complement other available prevention strategies.