Preexposure Prophylaxis to Prevent Acquisition of HIV

Abstract

ImportanceAn estimated 1.2 million persons in the US currently have HIV, and more than 760 000 persons have died of complications related to HIV since the first cases were reported in 1981. Although treatable, HIV is not curable and has significant health consequences. Therefore, effective strategies to prevent HIV are an important public health and clinical priority.ObjectiveThe US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of preexposure prophylaxis with antiretroviral therapy for the prevention of HIV acquisition, and the diagnostic accuracy of risk assessment tools to identify persons at increased risk of HIV acquisition.PopulationAdolescents and adults who do not have HIV and are at increased risk of HIV.Evidence AssessmentThe USPSTF concludes with high certainty that there is a substantial net benefit from the use of effective antiretroviral therapy to reduce the risk of acquisition of HIV in persons at increased risk of acquiring HIV.RecommendationThe USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV. (A recommendation)

Knowledge, sex, and region associated with primary care providers prescribing adolescents HIV pre-exposure prophylaxis

“…Medical providers have noted in prior research that patient characteristics and providers’ perceptions of patients play a part in their intention to prescribe and in their actual prescribing of PrEP to adolescents 12 – 15 , 17 , 18 . Fourth, our study only analyzed prior prescription of PrEP and not other USPSTF recommendations regarding PrEP identification, discussion, and care, such as taking an HIV risk assessment to identify adolescents at risk of contracting HIV, educating adolescent patients and their parents about PrEP, or discussing the risks and benefits of the different PrEP medications and modalities (e.g., Truvada® v. Descovy® v. Apretude®; daily oral v. long-acting injectable) 4 .…”

“…In 2019, adolescents and young adults (13–24 years old) accounted for one-fifth of new HIV infections in the United States (US) 1 . The Ending the HIV Epidemic (EHE) 2 initiative, the Centers for Disease Control and Prevention (CDC) 3 , and the US Preventive Services Task Force (USPSTF) 4 recommend primary care providers (PCPs) prescribe HIV pre-exposure prophylaxis (PrEP) to patients at risk for contracting HIV and who meet PrEP eligibility requirements, including adolescents. Although adolescents and young adults are at risk of contracting HIV, adolescents and young adults have the greatest unmet need for PrEP among all other age groups 5 – 9 .…”

HIV and Undetectable = Untransmittable (U=U)

“…However, the degree of effectiveness varied based on the level of adherence (less effective when not taken as prescribed) and was founded on its use in combination with safer sex practices 8 . Being that PrEP only protects against HIV, it is critical not to obfuscate the message that condom use remains important and proven for protection against other STIs and that barrier protective measures are also vital in helping prevent HIV if PrEP is not taken as prescribed 9 . Two additional agents, emtricitabine/tenofovir alafenamide (Descovy) and the long-acting injectable integrase inhibitor drug, cabotegravir (Apretude), each indicated for specific populations, have since also been approved for PrEP 9 .…”

“…Being that PrEP only protects against HIV, it is critical not to obfuscate the message that condom use remains important and proven for protection against other STIs and that barrier protective measures are also vital in helping prevent HIV if PrEP is not taken as prescribed 9 . Two additional agents, emtricitabine/tenofovir alafenamide (Descovy) and the long-acting injectable integrase inhibitor drug, cabotegravir (Apretude), each indicated for specific populations, have since also been approved for PrEP 9 . In those who are compliant, PrEP has been found to diminish the risk of contracting HIV from sexual activity by approximately 99% and from injection drug use by at least 74%.…”

“…The assurance that ART and PrEP would prevent HIV has led to an increase in condomless sexual activity 31 . Although the substantial increased number of reported cases of STIs is not proven to be a direct consequence of a decreased use of condoms or change in sexual behaviors, 9 it has served to reignite interest in the idea of STI and HIV epidemiologic synergism 32 . Awareness that an STI could enhance the transmission and chance of becoming infected with HIV first gained attention after it was established that genital herpes simplex facilitated the spread of this retrovirus 33 .…”