Healthy people at risk for HIV should take a daily pill to minimise their chances of getting the virus, according to new guidelines from an influential panel of US physicians.
Anyone at risk for HIV - including people with HIV-positive partners, people who have unprotected sex with at-risk individuals, and people who inject illegal drugs - should take the daily pill, called Truvada, to prevent the virus, according to recommendations issued today by the US Preventive Services Task Force (USPSTF). The Task Force, a government-backed panel that reviews medical evidence, helps shape what services are offered by primary care providers and covered by insurance.
In recent decades, antiretroviral therapy has helped transform HIV (the human immunodeficiency virus) from a near-certain death sentence into a chronic, manageable disease. Truvada, which combines the medicines tenofovir and emtricitabine, is used to treat HIV and also for a prevention regimen known as pre-exposure prophylaxis (PrEP).
"This is the first time the Task Force has recommended PrEP," said Dr. Paul Volberding, director of the University of California San Francisco AIDS Research Institute. The acronym, PrEP, stands for "pre-exposure prophylaxis."
"It will dramatically encourage PrEP use and will help force price reductions that are a major current barrier to this essential HIV prevention tool," Volberding, coauthor of an editorial accompanying the recommendations in JAMA, said by email.
An estimated 1.1 million people in the United States have HIV, including about 162,500 people who are unaware of their status, according to the US Centres for Disease Control and Prevention (CDC).
Each year, about 40,000 people in the US are diagnosed with HIV. About 40 per cent of new infections are transmitted by people who didn't know they had the virus, according to the CDC.
PrEP can lower the risk of getting HIV from sex by up to 90 per cent, according to the CDC. Even among people who inject illegal drugs, PrEP can reduce the risk of HIV by more than 70 per cent.
And when people on PrEP continue to use condoms, their risk of developing HIV is even lower, the CDC says.
Even though PrEP is highly effective, many people who could benefit from the pill don't take it because they aren't aware of it or because it's unavailable or unaffordable. Some patients also take their PrEP inconsistently, making it less effective.
There's little downside to taking PrEP.
Side effects are mild and reversible and include problems with the kidneys and gastrointestinal tract, the Task Force notes. There is also some concern that PrEP may increase the spread of other sexually transmitted infections if users decrease condom use because they mistakenly believe the pill protects against those diseases, too.
Screening is also key for prevention, and the USPSTF today reiterated its long-standing recommendation that all pregnant women and everyone ages 15 to 65 get tested. Some older or younger people at high risk for HIV should also get HIV tests.
Less than half of US adults have been screened for HIV, and screening rates are low even among high-risk individuals like injection drug users, according to the CDC.
"The fact that not enough Americans are getting tested for HIV is deeply concerning, and we hope this recommendation will encourage more people to be screened," Task Force member Dr. John Epling, Jr. of the Virginia Tech Carilion School of Medicine in Roanoke said by email.
The Task Force didn't weigh in on how often people should be screened, citing a lack of evidence to identify the ideal frequency.
"In the setting of PrEP we aim for HIV testing every 3 months," Volberding said.
"Testing is especially recommended for those engaging in high exposure behaviours, men who have sex with men, injection drug users, sex workers, etc.," Volberding added. "And all infants born to HIV-infected moms should be screened as well."