prevention

USPSTF: PrEP Use Is Recommended for all At-Risk Populations

The US Preventive Services Task Force (USPSTF) now recommends pre-exposure prophylaxis (PrEP) therapy for at-risk populations in a first-ever draft recommendation statement.

“Once-daily oral treatment with combined tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) is the only formulation of PrEP approved by the US Food and Drug Administration for use in the United States in persons at risk of sexual acquisition of HIV infection,” the USPSTF wrote. 

“However, several studies reviewed for this recommendation statement found that tenofovir alone was also effective as PrEP, and USPHS guidelines note that, given this trial data, tenofovir alone can be considered as an alternative regimen for high-risk heterosexual men and women and persons who inject drugs.”

More than 1 million Americans are currently living with HIV, and since the first cases were reported in 1981, more than 700,000 persons have died from AIDS. Although the infection is treatable, there is currently no cure—which is why the USPSTF says it is important to target the at-risk populations with preventive medication. 

Among its recommendations are:

  • The USPSTF found adequate epidemiologic data about risk factors that can identify individuals at high risk of acquiring HIV infection.
  • The USPSTF found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in individuals at high risk of HIV infection. 
  • The USPSTF found convincing evidence that adherence to PrEP is highly associated with its efficacy in preventing the acquisition of HIV infection.
  • The USPSTF found adequate evidence that PrEP can cause small harms, including renal and gastrointestinal adverse events.

 

In addition, the at-risk populations for HIV infection who should be considered for PrEP therapy include:

  • Men who have sex with men, are sexually active, and have one of the following characteristics:
    • A serodiscordant sex partner
    • A recent infection with syphilis, gonorrhea, or chlamydia
    • Inconsistent use of condoms
  • Heterosexual women and men who are sexually active and have one of the following characteristics:
    • A serodiscordant sex partner
    • Inconsistent use of condoms during sex with a partner whose HIV status is unknown and who is at high risk 
    • A recent infection with syphilis or gonorrhea
  • Individuals who inject drugs and have one of the following characteristics:
    • Share drug injection equipment
    • Are at risk of sexual acquisition of HIV

 

“The USPSTF concludes with high certainty that there is a substantial net benefit from the use of PrEP to reduce the risk of acquisition of HIV infection in persons at high risk of HIV infection,” the recommendation concluded.

—Amanda Balbi

Reference:

Draft recommendation statement: Prevention of human immunodeficiency virus (HIV) infection: pre-exposure prophylaxis [published online November 2018]. US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis.