Prevention of HIV: US Preventive Services Task Force
U.S Preventive Services Task Force. Draft Recommendation Statement. Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis.
December 1, 2018 marked the 30th Anniversary World AIDs Day, and much has happened in in the 37 years since the first cases were reported. In the U.S. alone an estimated 700,000 people have died of HIV, 1.1 million individuals are currently infected, and HIV infection has gone from a death sentence to a manageable chronic infection with the advent of highly effect antiretroviral therapy. Now, in the era of pre-exposure prophylaxis (PrEP), HIV is becoming an avoidable infection. Although 1.2 million individuals in this country could benefit from PrEP, less than 7% of them receive PrEP. This may change in the near future.
The US Preventive Services Task Force (USPSTF) recently published its draft recommendation statement on PrEP.[1] The USPSTF commissioned a systematic review of the evidence and found convincing evidence that “PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV infection…” They also concluded that adherence to PrEP is highly correlated with protection and that the potential for harm was small.
PrEP should be considered for the following groups:
Men who have sex with men are sexually active and have any of the following:
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a sex partner with HIV
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a recent sexually transmitted infection (STI)
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inconsistent use of condoms in the setting or receptive or insertive anal sex
Heterosexual women and men who are sexually active and have any of the following:
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A sex partner with HIV
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Inconsistent use of condoms with high risk partner with unknown HIV status
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Recent syphilis or gonorrhea
Anyone who injects drugs and has any of the following:
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Sharing drug injection equipment
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At risk for sexual acquisition of HIV (as above)
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Keep in mind that risk stratification is contingent on obtaining a thorough sexual and injection drug history; something that is far too uncommon in usual practice.
This draft recommendation is open to public comment until December 26, 2018. The final will be drafted after careful consideration of feedback received. In the meanwhile, work on getting better histories on your patients and considering PrEP in appropriate situations.
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