Title: US Preventive Services Task Force Expands Recommendations for HIV Antiretrovirals
Subtitle: Task Force Aims to Extend Pre-Exposure Prophylaxis to a Wider Population
Date: August 22, 2023
The US Preventive Services Task Force (USPSTF) has updated its recommendation for antiretroviral medications used in the prevention of HIV. With the introduction of new options in the market, the task force believes that pre-exposure prophylaxis (PrEP) can be extended to a broader population.
According to Dr. James Stevermer, a member of the task force and a professor at the University of Missouri, the availability of new options allows them to consider expanding PrEP. He states, “With these new options we could potentially extend pre-exposure prophylaxis (PrEP) to a wider population.”
The updated guidance, published in JAMA on August 22, takes into account the recent approvals by the US Food and Drug Administration, including a long-acting injectable form. Previously, the only approved medication was daily oral tenofovir disoproxil fumarate with emtricitabine, which the task force recommended. However, two new regimens have since been approved: daily oral tenofovir alafenamide with emtricitabine and the long-acting injectable cabotegravir.
The task force now supports all three options and recommends that clinicians choose the formulation that is most suitable for their patients at risk of HIV infection.
The USPSTF is a group of primary and preventative care experts who provide recommendations on preventive interventions across various fields. Their recommendations are particularly beneficial for clinicians who may not specialize in HIV care, as it helps them stay updated on the latest advances. Dr. Carolyn Chu, chief medical officer of the American Academy of HIV Medicine, believes that the expanded recommendations will catch the attention of those who may not be aware of recent HIV updates.
Individuals’ risk of HIV infection is mainly determined by their behavior. Those who engage in behaviors such as injectable drug use, inconsistent condom usage, unknown partner HIV status, or recent bacterial sexually transmitted infections are at a higher risk. The task force acknowledges that the efficacy of each of the three options is similar and urges clinicians to consider their patients’ preferences and ability to adhere to the prescribed regimen.
Dr. Stevermer emphasizes the importance of medication adherence, stating, “The evidence is very clear that being able to adhere to taking the medication daily was very closely associated with the effectiveness of PrEP.” Laying emphasis on the integration of PrEP into routine healthcare, the task force believes this is crucial for its effectiveness.
Expanding access to antiretrovirals is a vital component of the Ending the HIV Epidemic in the US initiative, which aims to reduce new HIV cases by 90% by 2030. However, an editorial accompanying the recommendation highlights the disproportionately low uptake of PrEP among the populations most affected by HIV.
According to the data, in 2021, 78% of White individuals deemed eligible for PrEP received it, compared to only 11% of Black individuals and 21% of Hispanic individuals. It is important to note that Black and Hispanic populations have a higher HIV incidence compared to White individuals. Additionally, PrEP usage is considerably lower among cisgender and transgender women, youth, and people who inject drugs. Dr. Stevermer emphasizes the need to reach out and provide this intervention to populations at a higher risk of HIV.
Dr. Chu believes that having multiple options for PrEP is essential in expanding access to underserved groups. She states, “Even though oral tenofovir disoproxil fumarate with emtricitabine has been out for a while, we know it’s not getting to everyone, and there may be clinical circumstances that means it’s not the right option.” Supporting individual decision-making ensures that patients can choose the most suitable option for themselves.
Additionally, healthcare providers must approach the topic of PrEP with their patients in a non-judgmental and stigma-free manner to promote open conversation. Dr. Chu emphasizes the importance of changing the narrative surrounding PrEP and integrating it into preventive care portfolios to initiate discussions about this effective and safe treatment.
The USPSTF’s expansion of recommendations for HIV antiretrovirals brings renewed hope for reducing new HIV cases. By recognizing the importance of various treatment options and encouraging open dialogue, healthcare providers can effectively combat the HIV epidemic.
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Sources:
– JAMA. Published online August 22, 2023. Full Text, Editorial
– Medscape