Over the past few decades, doctors and researchers have made admirable progress in controlling the spread of HIV, mainly by using anti-HIV drugs in powerful combinations that can make it harder for the virus to infect cells and pump out more copies of itself. But as any infectious-disease expert knows, preventing new infections is equally as important as treating existing cases to contain an epidemic. And in the U.S. each year, nearly 40,000 people are still newly diagnosed with HIV.
With its latest recommendation, published in JAMA, the U.S. Preventive Services Task Force (USPSTF) issued its strongest strategy yet for preventing HIV. The Task Force is an independent panel of experts that reviews available data and makes recommendations on various health issues. Many medical organizations rely on this advice for treating patients. Based on the studies it analyzed, the USPSTF now recommends that people who are not yet infected with HIV but are at high risk of becoming infected start taking PrEP, or Pre Exposure Prophylaxis, a daily medication most commonly made up of tenofovir disoproxil fumarate paired with emtricitabine (sold under the brand name Truvada), or composed of tenofovir alone. The drugs are extremely effective at preventing HIV from infiltrating healthy immune cells, essentially acting as a barrier to infection.
Gay men are considered at “high risk” of developing HIV, and the task force also includes those who have sex without a condom, people who have sex with partners who don’t know their HIV status, and IV drug users.
“If we’re going to try to end the HIV epidemic in the way the President talked about in February of this year, then we’ve got to get a lot more people using PrEP,” says Dr. Anthony Fauci, director of the National Institute on Allergy and Infectious Diseases of the National Institutes of Health, referring to the Trump Administration’s proposal to reduce new infections by 75% over the next five years and by 90% over the next decade. Currently, he says, there are up to 1.2 million people in the U.S. who are potentially at higher risk of getting an HIV infection than the general population, but fewer than 30% of them are taking advantage of PrEP.
Preexposure Prophylaxis for the Prevention of HIV Infection
US Preventive Services Task Force Recommendation Statement
Importance An estimated 1.1 million individuals in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. In 2017, there were 38 281 new diagnoses of HIV infection reported in the United States; 81% of these new diagnoses were among males and 19% were among females. Although treatable, HIV infection has no cure and has significant health consequences.
Objective To issue a new US Preventive Services Task Force (USPSTF) recommendation on preexposure prophylaxis (PrEP) for the prevention of HIV infection.
Evidence Review The USPSTF reviewed the evidence on the benefits of PrEP for the prevention of HIV infection with oral tenofovir disoproxil fumarate monotherapy or combined tenofovir disoproxil fumarate and emtricitabine and whether the benefits vary by risk group, population subgroup, or regimen or dosing strategy; the diagnostic accuracy of risk assessment tools to identify persons at high risk of HIV acquisition; the rates of adherence to PrEP in primary care settings; the association between adherence and effectiveness of PrEP; and the harms of PrEP when used for HIV prevention.
Findings The USPSTF found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV acquisition. The USPSTF also found convincing evidence that adherence to PrEP is highly associated with its efficacy in preventing the acquisition of HIV infection; thus, adherence to PrEP is central to realizing its benefit. The USPSTF found adequate evidence that PrEP is associated with small harms, including kidney and gastrointestinal adverse effects. The USPSTF concludes with high certainty that the magnitude of benefit of PrEP with oral tenofovir disoproxil fumarate–based therapy to reduce the risk of acquisition of HIV infection in persons at high risk is substantial.
Conclusions and Recommendation The USPSTF recommends offering PrEP with effective antiretroviral therapy to persons at high risk of HIV acquisition. (A recommendation)