Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Preexposure Prophylaxis to Prevent HIV Acquisition

Can new intervention reduce HIV infections?

Increasing delivery of preexposure prophylaxis (PrEP) and other highly effective HIV prevention services could lower the number of new HIV infections occurring in the US each year, according to an analysis that estimated the number of persons in the US with indications for PrEP. The study found:

• Approximately 1 in 4 sexually active HIV-negative adult men who have sex with men (MSM) have indications for PrEP.

• An estimated 1 in 5 HIV-negative persons who inject drugs have indications for PrEP.

• An estimated 1 in 200 HIV-negative heterosexually active adults have indications for PrEP.

• Persons at substantial risk for HIV infection and their health care providers need to be aware of daily oral PrEP as one of several highly effective HIV prevention methods.

Citation: Smith DK, Van Handel M, Wolitski RJ, et al. Vital signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition – United States, 2015. MMWR 2015;64(46);1291-1295.

Commentary: Daily preexposure prophylaxis (PrEP) for high risk HIV-negative individuals is effective at decreasing the rate of acquisition of HIV infection. Efficacy is in the range of 70% to 90%.1,2 The effectiveness of PrEP was recently confirmed in a real-world setting, showing PrEP is effective and that prescription of PrEP does not lead to an increase in risk-taking sexual behavior. PrEP is recommended by the CDC, and has received a lot of attention in the lay literature. This study shows up to 1.2 million people in the United States are good candidates for PrEP. —Neil Skolnik, MD

1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363:2587–2599.

2. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367:399–410.