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December 9, 2015
CDC: Broader Use of Pre-Exposure Prophylaxis Could Reduce New HIV Cases
Atlanta—New cases of human immunodeficiency virus (HIV) were diagnosed in 40,000 patients in the United States in 2014. A report from the national Centers for Disease Control and Prevention suggests that number could be substantially reduced with broader use of pre-exposure prophylaxis (PrEP) with daily oral antiretroviral medication. 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 Updated to 2020 calls for the scale-up of the delivery of PrEP and other highly effective prevention services to reduce new HIV infections. “The large percentage of persons at substantial risk for acquiring HIV infection in some transmission risk groups demonstrates a continuing need for access to, and use of, a broad range of high-impact, clinic-based HIV prevention services that includes increased access to PrEP,” study authors write. “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 United States 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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