Who Should Be Taking PrEP Now?
Updated December 01, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
The daily use of Truvada (tenofovir + emtricitabine) has been shown to reduce the risk of acquiring HIV by as much as 92%. The strategy, known as HIV pre-exposure prophylaxis (PrEP), is regarded as an effective means by which to stop the spread of the HIV to non-infected persons and to potentially reverse the rate of infections within high-risk populations.
Currently, of all high-income countries in North America and Europe, the U.S.
has both the highest HIV incidence rate (50,000 new infections each year) and the second highest HIV prevalence rate (0.6%, or approximately 1.2 million HIV-infected people) all countries. Only Lavtia, a country with less than two million citizens and 10,000 diagnosed infections, has a higher prevalence rate (0.7%).
As result of these statistics, the U.S. Public Health Service (USPHS) released its updated clinical practice guidelines on May 14, 2014, calling for the daily use of PrEP in the HIV-negative individuals at substantial risk of infection, as follows:
Sexually active men who have sex with men (MSM) who are not in a monogamous relationship with a recently tested HIV-negative man, and meet one or more of the following criteria:
- Engage in condom-less anal sex (receptive or insertive).
- Have had a sexually transmitted infection (STI) within the past six months.
- Are in a serodiscordant (mixed status) relationship with an HIV-positive partner.
Sexually active men who have sex with men and women (MSMW) who are not in a monogamous relationship with a recently tested HIV-negative partner, and meet one or more of the following criteria:
- Engage in condom-less anal sex (receptive or insertive).
- Have had a sexually transmitted infection (STI) within the past six months.
- Are in a serodiscordant (mixed status) relationship with an HIV-positive partner.
Sexually active heterosexual men or women who are not in who are not in a monogamous relationship with a recently tested HIV-negative partner, and meet one or more of the following criteria:
- Infrequently use condoms with one or more partners of unknown HIV status with substantial risk of HIV (injecting drug users, MSMW).
- Are in a serodiscordant (mixed status) relationship with an HIV-positive partner.
Injecting drug users (IDUs) who meet have injected drugs in the past six months, and meet one or more of the following criteria:
- Share needles or have shared needles in the past six months.
- Have been on a methadone, buprenorphine or suboxone treatment program in the past six months.
- Have any of the above-listed risks of sexual acquisition.
In addition, PrEP can be prescribed for serodiscordant couples wanting to conceive or during pregnancy to reduce the risk of HIV to the non-infected partner. Both the FDA labeling and perinatal antiretroviral treatment guidelines provide for this.
PrEP can only be prescribed by a doctor and requires both an HIV test prior to start of therapy and every three months thereafter. Medicaid and most U.S. insurance plans cover the cost of PrEP, while co-pay drug assistance is available for those who qualify through Gilead's Truvada for PrEP Medication Assistance Program.
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Sources:
Centers for Disease Control and Prevention (CDC). “Pre-Exposure Prophylaxis (PrEP).” Atlanta, Georgia; accessed November 6, 2014.
World Health Organization (WHO). “Prevalence of HIV among adult 15 to 49 – Data by country.” Geneva, Switzerland; accessed November 6, 2014.
World Bank Group. “Country and Lending Groups.” Washington, D.C.; accessed November 6, 2014.
U.S. Public Health Service (PHS). "Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2014: A Clinical Practice Guideline." Washington, D.C.; published May 14, 2014; accessed November 6, 2014.
National Institutes of Health (NIH). "Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States." Bethesda, Maryland; accessed November 6, 2014.