What is PrEP?
PrEP is short for Pre-Exposure Prophylaxis and may be part of comprehensive HIV prevention services in which HIV negative people who are at high risk, take antiretroviral medication daily to try to lower their chances of becoming infected with HIV if they are exposed to it. To date, PrEP has only been shown to be effective in men who have men who have sex with men (MSM) and transgendered women who have sex with men. Studies are underway to evaluate whether it is safe and effective in reducing HIV infection among heterosexual men and women as well as injection drug users, but those results are not yet available.
In November 2010, the National Institutes of Health (NIH) announced the results of the iPrEx clinical trial, a large, multi-country research study examining whether a pill used to treat HIV can also help prevent HIV infection. The study found that daily oral use of tenofovir plus emtricitabine (brand name Truvada) provided an average of 44% additional protection to men who have sex with men (MSM) and transgendered women who also received a comprehensive package of prevention services that included monthly HIV testing, condom provision, and management of other sexually transmitted infections.
Studies are underway to evaluate whether it is safe and effective in reducing HIV infection among heterosexual men and women as well as injection drug users. A study evaluating oral Truvada for women was terminated early in April 2011 based on indications of a lack of efficacy. Preliminary results indicated that new HIV cases were equally distributed among the groups of women who received or did not receive Truvada in this study. Results from other studies are not yet available.
CDC is leading national efforts to develop formal Public Health Service guidelines for PrEP. Until those more detailed guidelines are available, CDC has developed interim guidance for physicians electing to provide PrEP for HIV prevention among high risk MSM (see graphic and other materials below). In addition, he US CDC has recently released the following preliminary guidance for PrEP use in the United States and suggested it be targeted to high risk MSM.provides the following initial cautions to MSM who may be interested in PrEP before Public Health Service guidelines are available:
To date, PrEP has only been shown to reduce HIV infection among gay and bisexual men, and transgendered women who have sex with men, and there are no data regarding its benefit among heterosexuals or injection drug users.
PrEP should only be used among individuals who have been confirmed to be HIV-negative. Initial and regular HIV testing is critical for anyone considering using PrEP. All individuals considering PrEP must also be evaluated for other health conditions that may impact PrEP use.
PrEP should never be seen as the first line of defense against HIV. It was only shown to be partially effective when used in combination with regular HIV testing, condoms, and other proven prevention methods. Men who have sex with menMSM should still:
◦ Use condoms correctly and consistently
◦ Get tested regularly to know their status and that of their partner(s) for certain
◦ Get tested – and treated if needed – for other sexually transmitted infections that can facilitate HIV transmission, such as syphilis and gonorrhea
◦ Get information and support to reduce drug use and sexual risk behavior
◦ Reduce their number of sexual partners
Taking PrEP daily is critical. The iPrEXis study found that PrEP provided a high level of protection only to those who took the pills regularly; protection was very low among those who did not adhere to the daily regimen well.
PrEP must be obtained and used in close collaboration with healthcare providers to ensure regular HIV testing, risk reduction and adherence counseling, and careful safety monitoring.
Anyone considering using PrEP should speak with their doctor.
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