In the Journals

USPSTF: PrEP should be offered to patients at high risk for HIV

The U.S. Preventive Services Task Force recently recommended that patients at high risk for HIV be offered pre-exposure prophylaxis, or PrEP, with effective antiretroviral therapy, according to a report in JAMA.

The Task Force also recommended screening for HIV in teenagers and adults aged 15 to 65 years, younger teenagers and older adults at increased risk, and all pregnant women.

The PrEP recommendation is based on 29 studies containing 55,000 participants and mirrors the USPSTF’s 2018 draft recommendation and 2013 final recommendation in this same clinical area, according to a USPSTF press release.

Roger Chou, MD, of the department of medical informatics and clinical epidemiology at Oregon Health & Science University and colleagues wrote that the 29 studies indicated PrEP decreased the risk for HIV infection vs. no PrEP after 4 months to 4 years and that most adverse events tied to PrEP’s use were reversible and mild.

“The findings of this review are generally consistent with those from other recent meta-analyses that found PrEP to be effective at reducing risk of HIV infection and found greater effectiveness in trials reporting higher adherence. The findings are strengthened by the inclusion of recent large new trials, including the only trial of event-driven PrEP and an open-label pragmatic trial,” Chou and colleagues wrote.

The Task Force wrote that there was “convincing evidence that PrEP is of substantial benefit,” to those at high risk, but added that research is needed regarding: which cohorts at risk for HIV acquisition would most benefit from PrEP; different drug regimens and dosing strategies; factors linked to adherence; ways to increase uptake and adherence; PrEP’s benefit for U.S. persons who are heterosexual, inject drugs and/or are transgender; safety and effectiveness during pregnancy and breastfeeding; likelihood of an increased risk for other STIs; and long-term safety and effectiveness.

In a related editorial, Hyman Scott, MD, of Bridge HIV in San Francisco and Healio editorial board member Paul A. Volberding, MD, of the AIDS Research Institute in San Francisco wrote that the USPSTF's recommendations highlight “remarkable progress in preventing and treating HIV infection” and positively impact the fight against HIV.

"Together, the health gains in HIV treatment, the resulting reduction in transmission, and PrEP provide the necessary tools to end the HIV epidemic. Success in the next chapter in confronting this epidemic demands that these tools be widely accessible and used. The USPSTF Recommendation Statements should help make this happen,” they wrote. – by Janel Miller

For more information:

CDC tools regarding PrEP for clinicians can be found at:

https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-provider-supplement-2017.pdf

https://www.cdc.gov/hiv/risk/prep/

References:

Chou R, et al. JAMA. 2019;doi:10.1001/jama.2019.2591.

Scott H, Voldberding PA. JAMA. 2019;published online ahead of print.

U.S. Preventive Services Task Force. JAMA. 2019;doi:10.1001/jama.2019.6390.

Disclosures: Please see the studies for the authors’ relevant financial disclosures.

 

The U.S. Preventive Services Task Force recently recommended that patients at high risk for HIV be offered pre-exposure prophylaxis, or PrEP, with effective antiretroviral therapy, according to a report in JAMA.

The Task Force also recommended screening for HIV in teenagers and adults aged 15 to 65 years, younger teenagers and older adults at increased risk, and all pregnant women.

The PrEP recommendation is based on 29 studies containing 55,000 participants and mirrors the USPSTF’s 2018 draft recommendation and 2013 final recommendation in this same clinical area, according to a USPSTF press release.

Roger Chou, MD, of the department of medical informatics and clinical epidemiology at Oregon Health & Science University and colleagues wrote that the 29 studies indicated PrEP decreased the risk for HIV infection vs. no PrEP after 4 months to 4 years and that most adverse events tied to PrEP’s use were reversible and mild.

“The findings of this review are generally consistent with those from other recent meta-analyses that found PrEP to be effective at reducing risk of HIV infection and found greater effectiveness in trials reporting higher adherence. The findings are strengthened by the inclusion of recent large new trials, including the only trial of event-driven PrEP and an open-label pragmatic trial,” Chou and colleagues wrote.

The Task Force wrote that there was “convincing evidence that PrEP is of substantial benefit,” to those at high risk, but added that research is needed regarding: which cohorts at risk for HIV acquisition would most benefit from PrEP; different drug regimens and dosing strategies; factors linked to adherence; ways to increase uptake and adherence; PrEP’s benefit for U.S. persons who are heterosexual, inject drugs and/or are transgender; safety and effectiveness during pregnancy and breastfeeding; likelihood of an increased risk for other STIs; and long-term safety and effectiveness.

In a related editorial, Hyman Scott, MD, of Bridge HIV in San Francisco and Healio editorial board member Paul A. Volberding, MD, of the AIDS Research Institute in San Francisco wrote that the USPSTF's recommendations highlight “remarkable progress in preventing and treating HIV infection” and positively impact the fight against HIV.

"Together, the health gains in HIV treatment, the resulting reduction in transmission, and PrEP provide the necessary tools to end the HIV epidemic. Success in the next chapter in confronting this epidemic demands that these tools be widely accessible and used. The USPSTF Recommendation Statements should help make this happen,” they wrote. – by Janel Miller

For more information:

CDC tools regarding PrEP for clinicians can be found at:

https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-provider-supplement-2017.pdf

https://www.cdc.gov/hiv/risk/prep/

References:

Chou R, et al. JAMA. 2019;doi:10.1001/jama.2019.2591.

Scott H, Voldberding PA. JAMA. 2019;published online ahead of print.

U.S. Preventive Services Task Force. JAMA. 2019;doi:10.1001/jama.2019.6390.

Disclosures: Please see the studies for the authors’ relevant financial disclosures.