“We have a major implementation gap when it comes to PrEP.”
While a cure for HIV has remained elusive, in recent years there have been great strides made in the prevention and management of HIV and AIDS, the disease the virus causes if left untreated.
Now, the Centers for Disease Control and Prevention wants to dramatically expand access to HIV prevention medication. Released on Wednesday, the CDC’s newest guidelines encourage more-frequent conversations about HIV prevention medications among health care providers and patients. The guidelines also highlight new medications recently approved by the Food and Drug Administration, and some pending FDA approval, to further increase those options.
Pre-exposure prophylaxis, known as PrEP, is preventative medication that reduces the risk of getting HIV from sex by up to 99% when taken as prescribed. When taken appropriately, it has a low risk of side effects and is highly effective.
But preliminary CDC data suggests that, as of 2020, only a quarter of people for whom PrEP was recommended were taking it.
“We have a major implementation gap when it comes to PrEP,” said Dr. Todd Ellerin, director of infectious disease at South Shore Health.
The cause for this gap appears to be twofold. Not all health care providers routinely discuss PrEP with their patients, and many patients may feel uncomfortable sharing details about their sexual practices.
“As providers, we don’t necessarily ask the questions regarding sexual behavior. We don’t screen as much as we should,” Ellerin added. “And it’s also possible that some patients may not be forthcoming with their sexual behaviors.”
The newest CDC guidelines aim to address this gap by recommending that health care providers discuss PrEP with every patient who’s sexually active.
“I think the most valuable update that could have been put in place was encouraging providers to have conversations about the benefits of PrEP, as many patients are not aware of its existence or the benefits,” said Dr. Darien Sutton, a board-certified emergency physician.
The CDC recommends PrEP for people who are at high risk of contracting HIV: those with a sexual partner who is HIV-positive, those who have had a bacterial sexually transmitted infection (STI) within the past 6 months, and those who do not use condoms or use condoms inconsistently. The CDC guidelines also recommend PrEP for those who inject drugs and have an HIV-positive injection partner or share injection equipment.
“I honestly have conversations about PrEP with any of my patients who are sexually active with more than one partner. I think that it really should just simply start there,” Sutton added.
Truvada and Descovy are pill forms of PrEP that need to be taken daily for at least a week to be fully effective, and for those who don’t want to take a daily pill another option may be on the horizon.
Cabotegravir is an injectable medication shown to be effective for HIV prevention in clinical trials and is pending FDA-approval for use as PrEP. If approved, it would only need to be injected once every two months.
“With regards to the Cabotegravir, you know, we’re hoping that that gets approved, and it’s definitely useful for people who don’t like to take a pill a day,” said Dr. Simone Wildes, an infectious disease specialist at South Shore Health.
Sara Yumeen, M.D., a dermatology resident at Brown University’s Warren Alpert Medical School, is a contributor to the ABC News Medical Unit. Todd Ellerin, M.D., consults for Gilead and ViiV, manufacturers of Truvada and Cabotegravir.
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