The U.S. Preventive Services Task Force (USPSTF) recommends prescription of preexposure prophylaxis (PrEP) with effective antiretroviral therapy for individuals at increased risk for HIV acquisition. This recommendation forms the basis of a final recommendation statement published in the Aug. 22/29 issue of the Journal of the American Medical Association.
Roger Chou, M.D., from the Oregon Health & Science University in Portland, and colleagues updated the 2019 review on PrEP to inform the USPSTF. Twenty randomized clinical trials with 36,543 participants and 12 studies of diagnostic accuracy with 5,544,500 participants were included in the review.
The researchers note that 11 trials in the 2019 review revealed that oral PrEP was associated with a reduced risk for HIV infection versus placebo or no PrEP, with greater efficacy seen in association with higher adherence. One new trial in men who have sex with men showed oral tenofovir alafenamide/emtricitabine was noninferior to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). Long-acting injectable cabotegravir was associated with a reduced risk for HIV infection compared with oral TDF/FTC in two new trials.
Based on these findings, the USPSTF concludes with high certainty that there is a considerable net benefit for use of effective antiretroviral therapy for reducing the risk for HIV acquisition in adolescents and adults at high risk. Clinicians should prescribe PrEP using effective antiretroviral therapy to those at increased risk (A recommendation).
“We’re still seeing that many people who could benefit from PrEP aren’t receiving this highly effective medication, particularly in Black, Hispanic, and Latino communities,” task force member James Stevermer, M.D., M.S.P.H., said in a statement.
Roger Chou et al, Preexposure Prophylaxis for the Prevention of HIV, JAMA (2023). DOI: 10.1001/jama.2023.9865
US Preventive Services Task Force, Preexposure Prophylaxis to Prevent Acquisition of HIV, JAMA (2023). DOI: 10.1001/jama.2023.14461
Albert Y. Liu et al, New USPSTF Guidelines for HIV Preexposure Prophylaxis, JAMA (2023). DOI: 10.1001/jama.2023.11700
Valeria D. Cantos et al, Updated USPSTF Recommendations for Preexposure Prophylaxis—New Choices, New Obstacles, JAMA Internal Medicine (2023). DOI: 10.1001/jamainternmed.2023.3929
Roger J. Bedimo et al, PrEParing for the End of the HIV Epidemic—A Public Health Imperative, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.30195
JAMA Internal Medicine
Journal of the American Medical Association
JAMA Network Open
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