New US guidelines recommend PrEP

The US Centers for Disease Control and Prevention (CDC) today released new guidelines recommending that pre-exposure prophylaxis (PrEP) should be considered for anyone HIV-negative who:

• Is in an ongoing sexual relationship with a partner living with HIV.
• Is a gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV negative.
• Is a heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, people who inject drugs or bisexual male partners of unknown HIV status), and is not in a mutually monogamous relationship with a partner who recently tested HIV negative.
• Has, within the past six months, injected drugs and shared equipment or been in a treatment programme for injection drug use.

The US Food and Drug Administration (FDA) approved PrEP on 17 July 2012, but this only licensed Truvada (tenofovir plus emtricitabine) for use in HIV-negative people as a prevention measure; it did not make recommendations as to who should be considered for PrEP. 

The CDC issued previous guidelines in July 2011, well before the FDA approval, and only approximately 750 prescriptions for PrEP were made before FDA approval. Uptake has slowly increased since then but is still surprisingly low amongst gay men, with only 9% of physicians ever having prescribed it. The New York Times in an article today comments that the CDC's recommendations "could transform AIDS prevention in the United States" and that, if followed strictly, they would result in a 50-fold increase in Truvada prescriptions a year.    

"HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States,” said CDC Director Tom Frieden. “PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the United States."