Management

Ending the HIV Epidemic With 2 New USPSTF Recommendations

Author:
Douglas K. Owens, MD, MS
Stanford University
US Preventive Services Task Force

Citation:

Owens DK. Ending the HIV epidemic with 2 new USPSTF recommendations [published online July 1, 2019]. Infectious Diseases Consultant.

 

HIV continues to be a very significant public health issue; 40,000 people are diagnosed with HIV each year, so this is a problem that requires our urgent attention. Therefore, the US Preventive Services Task Force (USPSTF) released 2 HIV recommendations: one updated recommendation on HIV screening1 and one new recommendation on pre-exposure prophylaxis (PrEP) therapy.2

What Are the Recommendations?

With respect to screening, we recommend that everyone between the ages of 15 and 65 years, and all pregnant women be screened for HIV. We also recommend clinicians offer PrEP therapy to people at high risk of getting HIV. As you may know, PrEP is a daily medication and is highly effective at preventing HIV when taken as prescribed. PrEP is not for everyone, though; it is indicated for people who do not have HIV but are at high risk for getting it.

Right now, in the United States, only one PrEP regimen is approved by the US Food and Drug Administration (FDA), called Truvada. More research is still needed on other medications that can be used as PrEP, and as evidence evolves, other medications may become approved by the FDA.

Who Is at High Risk for Acquiring HIV?

The people we recommend for consideration for PrEP include:

  • Those having sex with a partner who is HIV-positive,
  • Those having sex without a condom with a partner whose HIV status is unknown and is at high risk for HIV,
  • Those sharing drug-injection needles and syringes,
  • Those exchanging sex for money or drugs, and
  • Those who had a sexually transmitted infection within the past 6 months.

For people in these categories, we want to start the conversation about PrEP.

How do we End the HIV Epidemic by 2020?

HIV screening and PrEP for HIV are both highly effective interventions. HIV screening enables people who have HIV to be put on effective anti-retroviral medication, which will help them live longer and healthier lives. And PrEP is highly effective for preventing the acquisition of HIV for people who are at high risk, when it is taken as prescribed. Therefore, each of these interventions will help reduce the number of new HIV infections, help people with HIV live longer and healthier lives, and ultimately save lives.

We hope these guidelines will raise awareness of and will help focus people’s attention on the ongoing public health problem from HIV. In addition, we hope the guidelines will encourage clinicians to offer PrEP to appropriate people who are at high risk for HIV. Both of these interventions, if implemented, can reduce the number of new HIV infections and can help toward the goal of ending the HIV epidemic in the United States.

We still have a very large public health problem with HIV. We have effective interventions, but we know that not enough people are receiving them, PrEP in particular. Though focused on primary care clinicians, the new USPSTF’s recommendations are certainly pertinent to other clinicians who care for patients with HIV or those who are at risk for HIV.

 

Douglas K. Owens, MD, MS, is a professor of medicine and director of the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University. He is also the 2019-2020 Chair of the US Preventive Services Task Force.

 

References:

  1. Human immunodeficiency virus (HIV) infection: screening. US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1. Published June 2019. Accessed June 24, 2019.
  2. Prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis. US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis?ds=1&s=hiv. Published June 2019. Accessed June 24, 2019.