Present and future of HIV pre-exposure prophylaxis: a narrative review

Introduction: Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention, reducing the risk of transmission among at-risk populations. However, challenges remain in ensuring accessibility and adherence. Recent innovations, including long-acting injectable and implantable formulations, offer promising alternatives to daily oral regimens. Areas Covered: This narrative review examines the evolution of PrEP, covering tenofovir-based oral regimens, long-acting cabotegravir, lenacapavir, and dapivirine ring, as well as alternative delivery methods, including microneedle patches, rectal douches, and subdermal implants. We conducted a comprehensive literature search of clinical trials, real-world studies, and guidelines from major health organizations to assess the efficacy, safety, and implementation strategies of the intervention. Expert Opinion: While PrEP innovations enhance HIV prevention, their impact depends on accessibility, adherence support, and integration into public health programs. Long-acting formulations reduce adherence burdens but require strategic implementation and a robust organizational structure. Expanding provider involvement and addressing social and structural barriers will be crucial to optimizing PrEP uptake. Future research should prioritize equitable access, real-world effectiveness, and combined prevention strategies to accelerate progress toward the elimination of HIV.