{"id":5186,"date":"2014-05-15T14:56:53","date_gmt":"2014-05-15T18:56:53","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=5186"},"modified":"2015-06-04T14:32:22","modified_gmt":"2015-06-04T18:32:22","slug":"cdc-recommends-broader-use-of-pre-exposure-prophylaxis-can-we-make-it-happen","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/cdc-recommends-broader-use-of-pre-exposure-prophylaxis-can-we-make-it-happen\/2014\/05\/15\/","title":{"rendered":"CDC Recommends Broader Use of Pre-Exposure Prophylaxis &#8212; Can We Make It Happen?"},"content":{"rendered":"<p>Making a much stronger and more comprehensive statement than their earlier &#8220;Guidance,&#8221; the CDC is <a href=\"http:\/\/www.cdc.gov\/hiv\/pdf\/guidelines\/PrEPguidelines2014.pdf\" target=\"_blank\">now recommending tenofovir\/FTC (Truvada) for all Americans at high risk for HIV<\/a>.\u00a0More specifically, they recommend it\u00a0for a broad range of people who\u00a0have\u00a0certain risk factors (click to see full size image):<\/p>\n<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/05\/Guidance-for-PrEP1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5187\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/05\/Guidance-for-PrEP1.jpg\" alt=\"Guidance for PrEP\" width=\"593\" height=\"334\" \/><\/a><\/p>\n<p>One\u00a0certainly gets <em>why<\/em> this was done &#8212; as summarized nicely in <a href=\"http:\/\/www.nytimes.com\/2014\/05\/15\/health\/advocating-pill-us-signals-shift-to-prevent-aids.html?hp\" target=\"_blank\">this <em>Times <\/em>piece<\/a>, it&#8217;s easy to be &#8220;frustrated that the number of H.I.V. infections in the United States has barely changed in a decade, stubbornly holding at 50,000 a year, despite 30 years of official advice to rely on condoms to block transmission.&#8221;<\/p>\n<p>Plus, we know that PrEP really does work, provided people take it. An encouraging report from CROI this year found that adherence was nearly 80% among MSM seeking PrEP in three U.S. cities (Miami; Washington, DC; San Francisco).<\/p>\n<p>And I have been surprised that we haven&#8217;t yet seen much of a decline in HIV incidence, even with a broader number of our patients in care receiving suppressive antiretroviral therapy, which essentially eliminates the risk of transmission to others.<\/p>\n<p>However, it&#8217;s clear that the epidemic is being sustained by those <em>not <\/em>in care, which is why PrEP is so important. It also raises the first of several\u00a0major challenges for clinicians, as the highest rate of HIV in the USA right now is in a population that tends not to access care on a regular basis &#8212; young, African-American MSM.<\/p>\n<p>Other challenges:<\/p>\n<ul>\n<li>The risk assessment will have to be done on the front lines of care &#8212; that is, by primary care clinicians &#8212; as HIV-negative, at-risk patients do not see HIV\/ID specialists.<\/li>\n<li>These PCPs will have to get comfortable prescribing tenofovir\/FTC. It&#8217;s not that it&#8217;s complicated (&#8220;take one pill daily&#8221;), it&#8217;s just that it&#8217;s not a medication they currently use.<\/li>\n<li>They will also be responsible for monitoring both adverse events and (very importantly), incident HIV and other sexually transmitted infections.<\/li>\n<\/ul>\n<p>Because of these issues, in the few years since PrEP became an option for HIV prevention, we&#8217;ve been offering our PCPs a one-time ID consult to discuss the risks and benefits, with a strategy for further follow-up outlined for the primary provider.<\/p>\n<p>So can PrEP be more broadly adopted? I think we (meaning the patchwork U.S. healthcare system) can pull this off.<\/p>\n<p>But it won&#8217;t be easy.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Making a much stronger and more comprehensive statement than their earlier &#8220;Guidance,&#8221; the CDC is now recommending tenofovir\/FTC (Truvada) for all Americans at high risk for HIV.\u00a0More specifically, they recommend it\u00a0for a broad range of people who\u00a0have\u00a0certain risk factors (click to see full size image): One\u00a0certainly gets why this was done &#8212; as summarized nicely [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,8,9],"tags":[748,902,909,950],"class_list":["post-5186","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-patient-care","category-policy","tag-prep","tag-tdfftc","tag-tenofovirftc","tag-truvada"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5186","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=5186"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5186\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=5186"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=5186"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=5186"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}