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JAMA. 2019 Jun 11;321(22):2203-2213. doi: 10.1001/jama.2019.6390.

Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement.

Author information

1
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
2
Stanford University, Stanford, California.
3
Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York.
4
Fairfax Family Practice Residency, Fairfax, Virginia.
5
Virginia Commonwealth University, Richmond.
6
Harvard Medical School, Boston, Massachusetts.
7
University of California, San Francisco.
8
Oregon Health & Science University, Portland.
9
University of Iowa, Iowa City.
10
University of Pennsylvania, Philadelphia.
11
Virginia Tech Carilion School of Medicine, Roanoke.
12
Temple University, Philadelphia, Pennsylvania.
13
University of Alabama at Birmingham.
14
University of California, Los Angeles.
15
University of Massachusetts Medical School, Worcester.
16
Boston University, Boston, Massachusetts.
17
Northwestern University, Evanston, Illinois.
18
University of Hawaii, Honolulu.
19
Pacific Health Research and Education Institute, Honolulu, Hawaii.
20
Tufts University, Medford, Massachusetts.

Abstract

Importance:

An estimated 1.1 million individuals in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. In 2017, there were 38 281 new diagnoses of HIV infection reported in the United States; 81% of these new diagnoses were among males and 19% were among females. Although treatable, HIV infection has no cure and has significant health consequences.

Objective:

To issue a new US Preventive Services Task Force (USPSTF) recommendation on preexposure prophylaxis (PrEP) for the prevention of HIV infection.

Evidence Review:

The USPSTF reviewed the evidence on the benefits of PrEP for the prevention of HIV infection with oral tenofovir disoproxil fumarate monotherapy or combined tenofovir disoproxil fumarate and emtricitabine and whether the benefits vary by risk group, population subgroup, or regimen or dosing strategy; the diagnostic accuracy of risk assessment tools to identify persons at high risk of HIV acquisition; the rates of adherence to PrEP in primary care settings; the association between adherence and effectiveness of PrEP; and the harms of PrEP when used for HIV prevention.

Findings:

The USPSTF found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV acquisition. The USPSTF also found convincing evidence that adherence to PrEP is highly associated with its efficacy in preventing the acquisition of HIV infection; thus, adherence to PrEP is central to realizing its benefit. The USPSTF found adequate evidence that PrEP is associated with small harms, including kidney and gastrointestinal adverse effects. The USPSTF concludes with high certainty that the magnitude of benefit of PrEP with oral tenofovir disoproxil fumarate-based therapy to reduce the risk of acquisition of HIV infection in persons at high risk is substantial.

Conclusions and Recommendation:

The USPSTF recommends offering PrEP with effective antiretroviral therapy to persons at high risk of HIV acquisition. (A recommendation).

Summary for patients in

PMID:
31184747
DOI:
10.1001/jama.2019.6390
[Indexed for MEDLINE]

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