PrEP Guidelines Released

PrEP Guidelines Released

Thursday, May 15, 2014

Federal guidelines--and supplementary set of tools for clinicians and patients--were released May 14, 2014 on the use of a daily antiretroviral drug regimen for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV prevention. Key points in the summary of the PrEP guidelines, Preexposure Prophylaxis For The Prevention Of HIV Infection In The United States, 2014: A Clinical Practice Guideline, are as follows:

  • Consideration of PrEP is recommended for four high risk groups. More specifically, the guidelines state that PrEP "has been shown to be safe and effective in reducing the risk of sexual HIV acquisition in adults" who are "at substantial risk of HIV acquisition" and is thus "one prevention option" for these individuals. Additionally, the guidelines state that PrEP is "one of several options [that should be discussed with HIV discordant couples] to protect the uninfected partner during conception and pregnancy...."
  • Data are insufficient on the efficacy of PrEP for adolescents.
  • HIV infection must be excluded by symptom history and HIV testing immediately before PrEP is prescribed.
  • The only PrEP-recommended medication at this point is Truvada.
  • Patients on PrEP should be seen by a clinician every 3 months.
  • Renal function monitoring is crucial so that those experiencing renal failure discontinue PrEP.
  • Other risk reduction services should be provided to patients as clinical trial participants have not shown uniformly high levels of medication adherence, which is critical to PrEP's efficacy.

Accompanying the PrEP guidelines is a supplement for clinicians and patients, including, for example, a checklist to go through prior to initiating PrEP, PrEP FAQs, a MSM Risk Index tool to assess patients at high risk of HIV infection, and resources on counseling patients about adherence and other prevention measures.

The guidelines, which replace prior interim guidelines, were developed by a large group of experts comprised of federal, academic, research, and provider agency representatives.

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