{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T15:05:39Z","timestamp":1792249539041,"version":"4.4.0"},"reference-count":53,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01KI2016"],"award-info":[{"award-number":["01KI2016"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pre\u2010 and post\u2010exposure prophylaxis (PrEP and PEP) are important pillars of the HIV prevention portfolio to reduce the risk of acquisition just before or after HIV exposure. While PrEP efficacy has been elucidated in many randomized clinical trials, corresponding data for PEP is extremely difficult to obtain in a controlled setting. Consequently, it is almost impossible to study the impact of PEP initiation delay and duration on HIV risk reduction clinically, which would inform recommendations on PEP use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employ pharmacokinetics, pharmacodynamics and viral dynamics models, along with individual factors, such as drug adherence to investigate the impact of initiation delay and PEP duration on HIV risk reduction. We evaluated PEP using two\u2010 and three\u2010drug regimens with a TDF\/FTC backbone. Moreover, we study PEP efficacy in the context of PrEP\u2010to\u2010PEP transitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In our simulations, early initiation of PEP emerged as a pivotal factor for HIV risk reduction. We found that 2\u2010drug (TDF\/FTC) PEP may insufficiently protect when initiated &gt; 1 hour post\u2010exposure. When adding a third drug, early initiation was still a critical factor; however, over 90% efficacy could be achieved when PEP was initiated 48 hours post\u2010exposure and taken for at least 14\u201328 days, depending on the efficacy of the third\u2010drug component. When investigating PrEP\u2010PEP transitions, we observed that preceding PrEP can (1) contribute directly to prophylactic efficacy, and (2) boost subsequent PEP efficacy by delaying initial viral dynamics and building\u2010up drug concentrations, overall facilitating self\u2010managed transitioning between PrEP and PEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study confirms the critical role of early (&lt; 48 hours) PEP initiation, preferably with three drugs taken for 28 days. Self\u2010start with TDF\/FTC and later addition of a third drug is better than not self\u2010starting. Furthermore, our study highlights the synergy between recent PrEP intake and PEP and may help to inform recommendations on PEP use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.26454","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:06:20Z","timestamp":1750943180000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Modelling the impact of initiation delay, duration and prior PrEP on the efficacy of post\u2010exposure prophylaxis containing a tenofovir\/emtricitabine backbone"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3740-4450","authenticated-orcid":false,"given":"Lanxin","family":"Zhang","sequence":"first","affiliation":[{"name":"Project group 5 \u201cSystems Medicine of Infectious Disease\u201d, Robert\u2010Koch Institute Nordufer 20 Berlin 13353 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