USPSTF recommends clinicians prescribe PrEP to those at high risk for HIV

The U.S. Preventive Services Task Force has released a draft recommendation advocating for clinicians to prescribe preexposure prophylaxis to patients at increased risk for HIV.

The recommendation, an A grade, is consistent with the USPSTF’s 2019 ruling on preexposure prophylaxis (PrEP) use for reducing HIV infection in those who are at higher risk.

“Health care professionals can help protect their patients at increased risk for HIV by prescribing PrEP,” task force member John B. Wong, MD, a professor of medicine at Tufts University School of Medicine, said in a press release. “The availability of multiple effective PrEP medications is great news for patients and a positive step to helping reduce the impact of HIV in the U.S.”

The CDC reported that 30,635 new HIV cases were diagnosed in the U.S in 2020. HIV prevalence was particularly significant in the South, which accounted for 51% (n = 15,661) of all new cases.

In the draft evidence review, Roger Chou, MD, a professor of medicine at the Oregon Health & Science University, and colleagues analyzed data from 11 randomized control trials, which showed significant associations between oral PrEP use and a decrease in HIV risk among at-risk patients compared with placebo or no PrEP (RR = 0.46; 95% CI, 0.33-0.66).

The task force noted that PrEP should only be used for patients at increased risk. There are currently three PrEP medications approved by the FDA: Truvada (emtricitabine/tenofovir disoproxil fumarate), Descovy (emtricitabine/tenofovir alafenamide; Gilead Sciences) and most recently Apretude (cabotegravir; ViiV Healthcare), which was approved last year as the first long-acting injectable for HIV PrEP

According to the USPSTF, factors that can increase a patient’s risk for HIV include having sex with someone who has HIV, having a recent sexually transmitted infection, not using condoms consistently — especially with those at increased risk — and sharing drug injection needles. The task force encouraged clinicians to talk to patients about their sexual history and injection drug use to determine infection risk, and to be aware of barriers to PrEP prescriptions.

“Many people who would benefit from PrEP are not receiving this highly effective medication,” task force member Martha Kubik, PhD, RN, a professor at the School of Nursing, College of Health and Human Services at George Mason University, said in the release. “This is especially true of Black, Hispanic and Latino communities.”

According to CDC data, 25% of the 1.2 million persons for whom PrEP is recommended were prescribed the treatment in 2020. Only 9% (n = 42,372) and 16% (n = 48,838) of eligible Black and Hispanic patients were prescribed PrEP, respectively.

The CDC also reported that among all racial and ethnic age groups combined, the largest number of HIV infections in 2019 occurred among Black men aged 25 to 34 years.

“These inequities must be addressed to achieve the full benefit of PrEP,” Kubick said.

References:

• Estimated HIV incidence and prevalence in the United States, 2015-2019. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-26-1.pdf. Accessed Dec. 12, 2022.
• HIV in the United States by region: HIV diagnoses. https://www.cdc.gov/hiv/statistics/overview/diagnoses.html. Accessed Dec. 12, 2022.
• PrEP for HIV prevention in the U.S. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html. Accessed Dec. 12, 2022.
• Pre-exposure prophylaxis for the prevention of HIV infection: A systematic review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/prevention-human-immunodeficiency-virus-hiv-infection-prep. Published Dec. 13, 2022. Accessed Dec. 13, 2022.
• Pre-exposure prophylaxis for the prevention of HIV infection: U.S. Preventive Services Task Force draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/prevention-human-immunodeficiency-virus-hiv-infection-prep. Published Dec. 13, 2022. Accessed Dec. 13, 2022.
• Task force issues draft recommendation statement on PrEP for HIV prevention. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hiv-prep-draft-rec-bulletin.pdf. Published Dec. 13, 2022. Accessed Dec. 13, 2022.