Friday, December 1, 2017

PrEP Can Prevent the Spread of HIV

By M. Brett Cooper, MD
Houston Pediatrician/Adolescent Medicine Fellow

39,513. That is the estimated number of new HIV diagnoses in the United States in 2015, ac-cording to the Centers for Disease Control and Prevention (CDC). Although the number of new diagnoses fell nine percent from 2010-2014, certain populations remain most at risk, particularly men who have sex with men and IV drug users. These two groups together accounted for three-quarters (76 percent) of new diagnoses in 2015. With advances in HIV care, these numbers can be reduced even further. One of these medical advances is HIV pre-exposure prophylaxis (PrEP). PrEP is an oral medication taken once daily to prevent HIV infection. Truvada® is currently the only FDA-approved medication for use in patients aged 18 and older. When used in combination with other risk-reduction measures, PrEP can be more than 90 percent effective at reducing the risk of HIV infection when taken daily as prescribed. Both patients and physicians can help in-crease awareness and use of PrEP hopefully to achieve the goal of “Getting to Zero” new infec-tions. Here are some tips for patients and physicians.

Patients:
Even if your physician does not discuss your sexual history with you, empower yourself to speak up. If you frequently engage in condomless vaginal or anal sex and/or have sex under the influ-ence of drugs or alcohol, ask your physician about PrEP. PrEP may also be a good option for you if you are in a sexual relationship with a partner who is HIV positive. Ensure that you are tested for HIV and other sexually transmitted infections at least once per year. If you are concerned about the cost of PrEP, or you do not have insurance, do not worry. The manufacturer of the medication has a patient-assistance program that may make the medication free, depending on your income.

Physicians and other health care providers:
The CDC has developed a guide for clinicians to help them identify which patients would be good candidates to screen for PrEP. In order to identify at-risk patients, physicians should take a sexual history for every patient at least once per year. This includes what sites are used for inter-course, the gender of one’s partners, whether condoms are used, and whether intercourse takes place under the influence of substances. Admittedly, this can be an uncomfortable topic for many physicians to discuss. However, your patients may be just as uncomfortable initiating this conver-sation with you. In addition, all sexually active patients should receive an HIV screening test at least once per year, including adolescents. For those patients who screen negative and are at risk, providers can discuss PrEP and other risk reduction measures. For patients who screen positive, they should be promptly referred for treatment.

As we celebrate the 30th World AIDS Day today, let us not forget those patients whose lives were claimed by HIV/AIDS. PrEP and other HIV risk-reduction methods can bring us ever clos-er to the goal of zero new infections. Prompt identification of those who are HIV positive and referral to treatment can bring their viral loads (the amount of HIV in a person’s blood) to unde-tectable levels, effectively giving those patients no risk of transmitting the virus to others. With physicians and patients working together, we will one day be able to raise an AIDS-free genera-tion.

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