USPSTF Issues Guidance on PrEP Use in Individuals at High Risk of HIV

The US Preventive Services Task Force (USPSTF) issued new draft recommendations on HIV screening and prevention advising that clinicians offer pre-exposure prophylaxis (PrEP) to all individuals at high risk of acquiring HIV, according to the statement.

Further, the Task Force recommended that clinicians screen everyone aged 15 to 65 years old, as well as all pregnant women, for HIV. Additionally, younger and older individuals who are at increased risk should also be tested.

In a press release, the USPSTF noted that HIV infection rates among individuals aged 25 to 29 years old are on the rise, indicating a need for improved screening and prevention strategies. Based on its review of evidence, the Task Force found that PrEP is highly effective at preventing HIV when taken daily, and the benefits outweigh the harms.

“The evidence is clear: when taken as prescribed, PrEP is highly effective at preventing HIV,” Task Force member Seth Landefeld, MD, said in a statement. “To make a difference in the lives of people at high risk for HIV, clinicians need to identify patients who would benefit and offer them PrEP.”

In addition to taking PrEP, individuals can reduce their risk of acquiring HIV by consistently using condoms during sex, and for those who inject drugs, using clean needles and syringes.

High risk behaviors include having a sex partner who is living with HIV, having sex without a condom with a partner whose HIV status is unknown and who is at high risk for HIV, and sharing injection drug equipment. The recommendations urge health care providers to provide patients support in taking their PrEP, noting that when not taken properly, it is not as effective.

Currently, once-daily oral treatment with combined tenofovir disoproxil fumarate and emtricitabine (TDC-FTC) is the only formulation of PrEP approved by the FDA. The Task Force noted that several studies reviewed for this recommendation statement found that tenofovir alone was also effective as PrEP.

Additionally, limited data suggest that PrEP use is not associated with significant adverse effects in adolescents, but may be associated with slightly less bone growth than would be expected. USPSTF recommends that clinicians weigh all the factors when considering PrEP use in adolescents at high risk for HIV and be aware of local laws and regulations that may apply when providing PrEP to an adolescent minor.

“About 40,000 people are diagnosed with HIV each year. This is why the Task Force, once again, calls for universal screening for HIV in adolescents and adults ages 15 to 65 years and in all pregnant women,” Task Force member John Epling, MD, MSEd, said in a statement. “People deserve to know their HIV status so, if needed, they can start treatment early and live long, healthy lives.”

The Task Force’s draft recommendation statements and draft evidence reviews have been posted for public comment on the Task Force Web site at www.uspreventiveservicestaskforce.org. Comments can be submitted from November 20, 2018 to December 26, 2018 at www.uspreventiveservicestaskforce.org/tfcomment.htm.

References

US Preventive Services Task Force Issues Draft Recommendation Statements on HIV Screening and Prevention [news release]. USPSTF’s website. Accessed November 27, 2018.

Draft Recommendation Statement: Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis. US Preventive Services Task Force. November 2018. https://bit.ly/2P4C0JK.