September 7, 2023, Press staff – An update final recommendation of the U.S. Preventive Services Task Force calls on clinicians to prescribe pre-exposure prophylaxis along with effective antiretroviral therapy for people at increased risk of acquiring HIV.
Several medications available
THE examination of evidence discovered several medications that appeared effective in reducing the risk of sexually acquired HIV infection, including
- tenofovir disoproxil fumarate by mouth (taken alone or with emtricitabine),
- oral tenofovir alafenamide plus emtricitabine, and
- long-acting injectable cabotegravir.
The FDA has approved these drugs to reduce the risk of sexually acquired HIV infection in at-risk adults and adolescents; However, oral tenofovir alafenamide-emtricitabine has not been approved for use in individuals at risk of infection during receptive vaginal intercourse because its effectiveness has not been evaluated in these populations.
Research findings and gaps
Overall, the examination of evidence found that oral PrEP with tenofovir disoproxil fumarate, alone or with emtricitabine, was associated with a significantly reduced risk of HIV acquisition compared with placebo or no PrEP. There is also a strong association between patient adherence and PrEP effectiveness.
Oral tenofovir alafenamide-emtricitabine was not inferior to oral tenofovir disoproxil fumarate-emtricitabine in men who have sex with men. Review of the evidence indicated some positive short-term effects on bone mineral density, but also negative effects on lipid parameters and weight gain.
Long-acting cabotegravir was associated with a reduced risk of HIV acquisition compared to oral tenofovir disoproxil fumarate-emtricitabine in men who have sex with men, as well as transgender women and women. at higher risk.
No PrEP medication has received FDA approval to reduce the risk of contracting HIV from injection drug use. However, CDC Clinical Practice Guidelines indicate that people who inject drugs are likely to benefit from any FDA-approved PrEP medication, regardless of whether they have an identified risk from sexual activity.
The USPSTF called for more studies to fill research gaps on topics such as
- tools to identify people at increased risk of contracting HIV who would benefit from PrEP;
- different PrEP treatment regimens and dosing strategies;
- the safety and effectiveness of PrEP during pregnancy and breastfeeding; And
- whether PrEP use is associated with increased risk of other STIs.
Responses to public comments
In response to comments on a draft recommendation, the working group
- deleted the word “infection” to avoid stigmatizing language,
- highlighted that adherence support is a key part of PrEP provision,
- provided detailed information on the implications of stopping cabotegravir, and
- clarified that gender diverse people are a population for which additional research is needed to identify accurate and validated risk assessment tools.
Support Resources
The working group linked to several resources for clinicians and patients, a HIV prevention guide (available in English and Spanish); A list of PrEP best practicesA clinical practice guide and one PrEP webpage with more resources.
The Academy also offers resources, including A AFP collection content on HIV/AIDS, a self-study CME course in adult medicine which includes a session on HIV testing and prevention; and articles from familydoctor.org on Preparation And HIV medications.
