By The Centers for Disease Control and Prevention (CDC)
The Centers for Disease Control and Prevention (CDC) has updated its Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—A Clinical Practice Guideline. The updated guideline provides clinicians with current, evidence-based guidance and information on prescribing all types of HIV preexposure prophylaxis (PrEP) and increasing PrEP use among people who could benefit from it.
PrEP is a powerful tool for preventing HIV, and when taken as prescribed, it reduces the risk of getting HIV from sex by about 99% and from injection drug use by at least 74%. If you are a licensed provider, you can prescribe PrEP. Read on to learn about CDC’s new guidance, including graded recommendations from the US Preventive Services Task Force (USPSTF) and four key changes to prescribing and managing patients on PrEP.
New Graded Recommendations from the US Preventive Services Task Force
Tell all your sexually active adult and adolescent patients that PrEP can protect them from getting HIV (Grade IIIB). Starting the conversation about PrEP will help your patients protect themselves from HIV and overcome embarrassment or stigma about discussing sex or injection drug use. You should also offer PrEP to anyone who asks for it, including patients who do not report HIV risk factors.
Prescribe cabotegravir (CAB) injections as PrEP for your sexually active adult and adolescent patients (Grade IA). CAB may be right for your patients who have difficulty taking oral PrEP as prescribed, would rather get a shot every 2 months instead of taking oral PrEP, and/or have serious kidney disease that stops them from using other PrEP medications.
The USPSTF is an independent panel composed of experts in prevention and primary care that reviews and makes recommendations about the evidence for and effectiveness of clinical preventive services. Grade A indicates that the USPSTF recommends the service, and there is high certainty that the net benefit of the service is substantial. USPSTF also recommends Grade B services. Grade B indicates that there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.
Review the updated PrEP guidelinefor a complete list of graded recommendations about PrEP.
Four Key Changes to CDC’s Guidance for Prescribing and Managing Patients on PrEP
- Descovy® (emtricitabine/tenofovir alafenamide [F/TAF]) is now included in the guideline as a daily oral PrEP medication for men and transgender women.
- Note that F/TAF has not yet been studied in and is not recommended for people assigned female sex at birth who could get HIV through receptive vaginal sex.
- Truvada® (or generic equivalent; emtricitabine/tenofovir disoproxil fumarate [F/TDF]) continues to be a daily oral PrEP option for adults and adolescents at risk of getting HIV through sex or injection drug use, regardless of their sex or gender.
- The recommended baseline and ongoing assessments for patients taking oral PrEP have changed. Consult the guideline to get detailed information about:
- The recommended frequency and methods of HIV and sexually transmitted infection (STI) screening and testing.
- Guidance on creatinine clearance and other assessments (e.g., triglyceride and cholesterol levels).
- The updated list of medications that may interact with F/TAF or F/TDF.
- Because Apretude® (CAB) injections are now approved by the US Food and Drug Administration, the updated PrEP guideline specifies recommended baseline and ongoing assessments for patients using injectable PrEP, including HIV and STI screening and testing.
- Note that regular kidney function, triglyceride, and cholesterol assessments are not needed for patients taking CAB injections.
- To make CDC’s guidance as easy to use as possible, the updated guideline includes detailed algorithms for important aspects of prescribing PrEP.
- Find flowcharts detailing how to assess HIV status for your patients who are starting PrEP (or restarting after a long stop) and your patients who are taking or have recently taken PrEP on pages 30 and 31 of the updated PrEP guideline.
- Access flowcharts on pages 23 and 27 of the updated PrEP guideline. The flowcharts can help you quickly assess indications for PrEP for your sexually active patients and patients who inject drugs.
In addition to the changes highlighted above, CDC’s updated PrEP guideline also:
- Summarizes the latest scientific evidence.
- Clarifies aspects of clinical care.
- Describes considerations for providing PrEP.
- Simplifies CDC’s guidance to make it easier to apply.
For more information about prescribing PrEP for HIV prevention to your patients, including a summary of what’s new, access the updated PrEP guideline.
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