Healthcare providers should consider advising the use of anti-HIV drugs by uninfected patients who are at substantial risk of infection, according to new clinical guidelines released by the CDC and the National Center for HIV/AIDS, Viral Hepatitis, STD, and Tb Prevention.
When taken daily as directed, PrEP, or pre-exposure prophylaxis, can reduce the risk of HIV infection by more than 90% according to a news release from the NCHHSTP and the CDC. Inconsistent use results in much lower levels of protection.
HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States, CDC Director Tom Frieden, MD, MPH, said in the release. PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the U.S.
The guidelines say that PrEP should be considered for patients who are not infected with HIV, but who have one of the following indications:
Anyone who is in an ongoing sexual relationship with an HIV-infected partner.
A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.
A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injecting drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.
Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.
The 67-page guideline offers advice on how to support adherence to the pill regimen and its use in combination with condoms and other proven risk-reduction strategies. A 43-page supplement for clinical providers provides checklists and interview guides to assist clinicians with PrEP prescribing and counseling.
Patients should be tested for HIV before PrEP is prescribed and at three-month intervals, while taking the drug. Regular testing ensures that anyone on PrEP who becomes infected with HIV discontinues PrEP use in order to minimize the risk that the virus could become resistant to the drugs, according to the release.
PrEP is a new approach to HIV prevention that requires continuing collaboration between patients and providers, as effectiveness requires adherence to daily medication and regular medical visits for monitoring, counseling and testing, said Dawn K. Smith, MD, MPH, the epidemiologist in CDCs Division of HIV/AIDS Prevention who led the development of the guidelines. Individuals will have to decide with their doctor if PrEP is right for them, but for some, this may offer a much-needed strategy to help protect themselves from HIV infection.
The CDC and other organizations are conducting pilot implementation studies and demonstration projects across the country to identify the most effective ways to deliver PrEP in community settings and reach those at high risk for HIV infection, according to the release.
While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today, Jonathan Mermin, MD, MPH, director of NCHHSTP, said in the release. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.
To access the guidelines PDF, go to http://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf
To view the provider supplement, go to http://www.cdc.gov/hiv/pdf/guidelines/PrEPProviderSupplement2014.pdf