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USPSTF Recommendation Statement: Preexposure Prophylaxis to Prevent Acquisition of HIV

Based on findings in an evidence report (covered in a separate PNN article), the U.S. Preventive Services Task Force (USPSTF) makes an “A” recommendation that clinicians prescribe preexposure prophylaxis (PrEP) using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV. “An estimated 1.2 million persons in the US currently have HIV, and more than 760,000 persons have died of complications related to HIV since the first cases were reported in 1981,” the panel writes. “Although treatable, HIV is not curable and has significant health consequences. Therefore, effective strategies to prevent HIV are an important public health and clinical priority.”

This statement replaces the 2019 USPSTF recommendation on PrEP for the prevention of HIV, the group explains. The new guidance is based on “12 studies that evaluated risk assessment tools developed in US cohorts for predicting incident HIV. Eight studies were conducted in men who have sex with men, 1 in persons who inject drugs, 1 in cisgender women, and 2 in the general population. Among the studies in men who have sex with men and persons who inject drugs that reported this measure, discrimination of the risk assessment tool was moderate, with an area under the receiver operating characteristic curve of 0.60 to 0.73. The 2 studies conducted in the general population evaluated 2 different risk assessment tools (number of items, 23 and 44) that used automated algorithms on electronic medical record data. These 2 studies reported moderate to high discrimination for incident HIV (area under the receiver operating characteristic curve, 0.77 [95% CI, 0.74-0.79] and 0.84 [95% CI, 0.80-0.89]). One study focused on cisgender women who had a positive HIV test result. It found that a 6-item risk assessment tool, based on electronic medical record data, had sensitivity of 95% for incident HIV (21 cases).”

Editorial: “The updated USPSTF recommendations for PrEP offer more choices for individuals to prevent HIV, adding safe new drugs that effectively prevent HIV, overcome prior medical contraindications to PrEP, and address adherence-related issues of oral PrEP,” editorialists write. “Although ensuring insurance coverage for all PrEP modalities through the ACA enforcement of these recommendations is a step in the right direction to correct the growing inequities in PrEP uptake and HIV incidence in the US, it will only benefit those with existing health insurance coverage and those residing in states that have expanded Medicaid. For individuals who are uninsured, underinsured, or not living in Medicaid expansion states, equitable access to PrEP will require a coordinated, federally funded, and state-supported strategy and, importantly, a broad societal understanding that investing in HIV prevention is cost-effective because it will prevent new HIV infections, something that will benefit us all as a country.”

Source: JAMA