New CDC Guidelines: People at Risk Should Consider PrEP
Health care providers should advise people at “substantial risk” about pre-exposure prophylaxis, or PrEP, to prevent HIV infection, according to new guidelines issued today by the Centers for Disease Control and Prevention (CDC). The FDA approved Truvada (tenofovir/emtricitabine) for PrEP in July 2012.
“HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States,” said CDC Director Tom Frieden. “PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the United States.”
The guidelines, available online, say PrEP should be considered for the following HIV-negative people:
- Anyone who is in an ongoing sexual relationship with an HIV-positive 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 CDC also put out a checklist for providers to help determine who might be appropriate candidates for PrEP.
Only Truvada taken daily has been approved for HIV prevention. Taking it sporadically before sex or as a “morning-after pill” has not been shown to be effective. HIV testing is crucial before starting PrEP because a person who already has HIV and takes Truvada without other antiretrovirals could develop drug-resistant virus.
The guidelines reflect research showing the effectiveness of PrEP for different populations. The iPrEx trial of mostly gay and bisexual men found that taking Truvada once daily reduced the risk of HIV infection by 42% overall—rising to as much as 99% among participants with blood drug levels indicating regular use as directed.
Similarly, the Partners PrEP and TDF2 trials, which looked at heterosexual couples in Africa, found that PrEP using Truvada or tenofovir alone reduced the risk of HIV acquisition by about 65%–75%. The Bangkok Tenofovir Study showed that daily tenofovir alone reduced HIV acquisition among people who inject drugs by about 50%. Effectiveness was lower among African women in the Fem-PrEP and VOICE due to lack of adherence.
“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,” said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “These guidelines represent an important step toward fully realizing the promise of PrEP. 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.”
Liz Highleyman (liz (at) hivandhepatitis.com) is a freelance medical writer and editor-in-chief of HIVandHepatitis.com.
Got questions about PrEP—and whether it’s right for you? Get answers at PrEPfacts.org, and check out BETA’s “virtual library” on PrEP for a myth-busting video, personal perspectives, answers to “burning questions,” and more.