Healthy people at risk for HIV should take a daily pill to minimize their chances of contracting the virus, according to new guidelines from an influential panel of North American physicians.
Anyone at risk for HIV – including people with HIV-positive partners, people who have unprotected sex with at-risk individuals and people who inject illegal drugs – should take the daily pill, called Truvada, to prevent the virus, according to recommendations issued today by the US Preventive Services Task Force (USPSTF). The Task Force, a government-backed panel that reviews medical evidence, helps shape which services are offered by primary care providers and covered by insurance.
In recent decades, antiretroviral therapy has helped transform HIV (the human immunodeficiency virus) from an almost certain death sentence into a chronic and manageable disease. Truvada, which combines the medicines tenofovir and emtricitabine, is used to treat HIV and also to a prevention regimen known as pre-exposure prophylaxis (PrEP).
"This is the first time the Task Force has recommended PrEP," said Dr. Paul Volberding, director of the AIDS Research Institute at the University of California, San Francisco. The acronym, PrEP, stands for "pre-exposure prophylaxis".
"This will dramatically boost the use of PrEP and help drive price reductions that are a major current barrier to this essential HIV prevention tool," Volberding, co-author of an editorial accompanying JAMA's recommendations, said in an e-mail.
An estimated 1.1 million people in the United States have HIV, including about 162,500 people who are unaware of their status, according to the US Centers for Disease Control and Prevention (CDC).
Each year, about 40,000 people in the US are diagnosed with HIV. About 40 percent of new infections are transmitted by people who did not know they had the virus, according to the CDC.
PrEP can reduce the risk of contracting HIV from sex by up to 90%, according to the CDC. Even among people who inject illegal drugs, PrEP can reduce the risk of HIV by more than 70%.
And when people in PrEP continue to use condoms, the risk of developing HIV is even lower, says the CDC.
Although PrEP is highly effective, many people who could benefit from the pill do not take it because they are unaware of it or are unavailable or inaccessible. Some patients also take their PrEP inconsistently, making it less effective.
There is little disadvantage in taking PrEP.
Side effects are mild and reversible and include problems with the kidneys and gastrointestinal tract, notes the Task Force. There is also some concern that PrEP may increase the spread of other sexually transmitted infections if users decline condom use because they mistakenly believe the pill also protects against those diseases.
Screening is also critical to prevention, and the USPSTF today reiterated its long-standing recommendation that all pregnant women and everyone aged 15-65 be tested. Some older or younger people at high risk of contracting HIV should also be tested for HIV.
Less than half of US adults have been tested for HIV, and screening rates are low, even among high-risk individuals such as injecting drug users, according to the CDC.
"The fact that few Americans are being tested for HIV is deeply troubling, and we hope this recommendation encourages more people to be tested," said Task Force member Dr. John Epling, Jr., of Virginia Tech School of Medicine Carilion in Roanoke. said by email.
The Task Force did not analyze the frequency with which people should be examined, claiming lack of evidence to identify the ideal frequency.
"In the PrEP scenario, we seek HIV testing every three months," Volberding said.
"The test is especially recommended for those who practice high-exposure behavior, men who have sex with men, injecting drug users, sex workers, etc.," added Volberding. "And all children born to HIV-infected mothers should also be screened."
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