Key clinical point: The USPSTF recommends pre-exposure prophylaxis (PrEP) plus effective antiretroviral therapy for people at high risk of HIV acquisition.
Major finding: In 11 clinical trials, PrEP was associated with reduced risk of HIV infection versus placebo or no PrEP (relative risk, 0.46; 95% confidence interval, 0.33-0.66).
Study details: A recommendation from the USPSTF on PrEP for prevention of HIV infection, based on a systematic review of English-language, placebo-controlled studies on the benefits and harms of PrEP, instruments for predicting incident HIV infection, and PrEP adherence.
Disclosures: All members of the USPSTF receive travel reimbursement and an honorarium for participating in meetings. The study was funded by the Department of Health and Human Services. One of the authors reported receiving grants from the National Institutes of Health/National Institute on Drug Abuse and serving as principal investigator of NIH-funded clinical trials that received donated drugs from two pharmaceutical companies. No other conflicts of interest were reported.
To end HIV, guidelines like this one that reflect and promote advances in treatment are needed, according to Hyman Scott, MD, MPH, of the San Francisco Department of Public Health and Paul A. Volberding, MD, of the University of California, San Francisco.
With less than 10% of individuals with an indication for PrEP currently receiving the medication, the time is now to “promote policies to expand PrEP access to those at risk,” the coauthors wrote. They noted that recent guidelines from the USPSTF show “a maturation of evidence and policy in HIV medicine and a growing consensus affecting application, not only in the United States but worldwide,” adding that “though the new recommendations seem secure, continued research will almost certainly allow further refinements.”
That said, sometimes the simplest solutions are also the best. Though the systematic review from Roger Chou, MD, and associates notes the necessity and importance of adherence, “clinician concern that a candidate for PrEP might be less fully adherent should not be used to withhold this medication,” they wrote. Averting new HIV infections is the goal, and fully endorsing treatments like PrEP is an important step in that direction.
These comments are adapted from an accompanying editorial (JAMA. 2019 Jun 11. doi: XXX). Dr. Volberding reported serving on a data and safety monitoring board for Merck.
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