CDC Releases Guidelines About Medications to Prevent HIV Infection

http://newsatjama.jama.com/2014/05/16/cdc-releases-guidelines-about-medications-to-prevent-hiv-infection/
BY JILL JIN, MD, MPH


The CDC has released its first set of comprehensive guidelines for preexposure prophylaxis (taking a daily pill that contains 2 anti-HIV drugs) for the prevention of HIV infection in high-risk individuals. Image: Gilead.

Physicians should consider prescribing antiretroviral medication to individuals who are not infected with HIV but are at high risk of infection, according to a new set of comprehensiveguidelines released this week by the US Centers for Disease Control and Prevention (CDC).

This approach, called preexposure prophylaxis, involves individuals who are not infected with HIV taking daily antiretroviral (anti-HIV) medications to prevent infection. Numerous clinical studies have shown this approach to dramatically reduce the chance of HIV infection in certain high-risk groups, such as men who have sex with men, people who are HIV negative but are in an ongoing relationship with a partner who is HIV positive, and people who use injection drugs.

In July 2012, the US Food and Drug Administration approved daily tenofovir/emtricitabine (Truvada), a pill that combines 2 anti-HIV medications, for preexposure prophylaxis in the United States. Now, the CDC has released recommendations to advise clinicians on which individuals may be considered candidates for this treatment. These include:

• Individuals who are in an ongoing relationship with a partner known to be infected with HIV
• Gay or bisexual men who have had sex without a condom or have been diagnosed with a sexually transmitted infection within the past 6 months
• Heterosexual men or women who have a high number of sexual partners, do not regularly use condoms, or have partners known to be at risk for HIV
• People who use injection drugs
• Commercial sex workers

Individuals taking Truvada to prevent HIV infection should be tested every 3 months to make sure they do not have HIV because Truvada alone is not the ideal treatment for known HIV infection. And importantly, preexposure prophylaxis should not take the place of other HIV prevention strategies, such as condom use, HIV counseling, and screening and treatment for other sexually transmitted diseases.

Researchers are studying the use of preexposure prophylaxis for adolescents and pregnant women, because evidence for its safety and effectiveness in these groups is much more limited. Current recommendations suggest that offering preexposure prophylaxis to these groups should be considered on an individual basis, with careful weighing of the risks and benefits.

The CDC also has information on the use of postexposure prophylaxis, which involves taking 4 weeks of antiretroviral therapy to prevent HIV infection after an event during which HIV exposure may have occurred, such as an accidental needlestick injury in a health care worker.