US Pharm. 2016;41(1):16.
HIV were diagnosed in the United States. A report from the CDC suggests that number could be substantially reduced with broader use of pre-exposure prophylaxis (PrEP) with daily oral antiretroviral medications.
The CDC study, published recently in the Morbidity and Mortality Weekly Report, found that about 24.7% of sexually active adult men who have sex with men (MSM), 18.5% of persons who inject drugs, and 0.4% of heterosexually active adults had substantial risks for acquiring HIV consistent with PrEP indications.
At the same time, several randomized, placebo-controlled clinical trials over the past 5 years have reported that, with high medication adherence, PrEP reduced new HIV infections by 92% among MSM, 90% among heterosexually active men and women in HIV-discordant couples, and 73.5% among injectable drug users.
In response to the gap between PrEP effectiveness and apparent underuse, the National HIV/AIDS Strategy 2020 calls for the scale-up of the delivery of PrEP and other highly effective prevention services to reduce new HIV infections. These services include: 1) regular HIV testing for all persons at substantial risk and their sexual or injection partners, and access to early antiretroviral treatment for persons with HIV infection to achieve viral suppression; 2) regular screening and treatment for sexually transmitted infections for persons with sexual risk when indicated, male and female condom access, and brief risk-reduction counseling to promote consistent condom use; and 3) for persons with injection risk, access to medication-assisted treatment or referral for behavioral treatment of addiction, and access to clean injection equipment for those continuing to inject.
The report notes that impact models indicate that 50% coverage and modest adherence to PrEP by high-risk MSM in the U.S. could reduce new infections in that group by 29% over 20 years. Based on models of PrEP use by heterosexually active adults in Botswana, where levels of viral suppression among HIV-infected persons equivalent to U.S. National HIV/AIDS Strategy 2020 goals have already been achieved, public health officials estimate that PrEP use could reduce new infections by at least 39% over 10 years.
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