HIV PrEP Recommended by USPSTF for High-Risk People

The U.S. Preventive Services Task Force's (USPSTF) latest recommendations include the use of new oral and injectable PrEP formulations.

An estimated 1.2 million people in the United States currently live with HIV, and over 760,000 individuals have died from HIV-related complications since the condition emerged in 1981.

However, when taken as prescribed, pre-exposure prophylaxis (PrEP) antiretroviral medications can reduce a person's chances of being infected with HIV by about 99%. Currently, most insurance plans cover PrEP at little or no cost, thanks to the Affordable Care Act.

Now, a new final recommendation statement by the U.S. Preventive Services Task Force (USPSTF) urges healthcare providers to provide PrEP to individuals at risk for HIV.

The recommendation is Grade A, meaning the Task Force strongly recommends that healthcare providers provide PrEP to at-risk patients.

Specifically, the USPSTF recommends that clinicians should consider PrEP for sexually active adults and teens weighing at least 77 pounds who have engaged in vaginal or anal sex in the past six months and have:

• A sexual partner who has HIV
• A sexually transmitted infection (STI) in the past six months
• A history of inconsistent or no condom use with sex partner(s) whose HIV status is unknown

In addition, physicians should consider PrEP for individuals who inject drugs and have a drug-injecting partner who has HIV or who shares injection equipment.

The new recommendations are similar to the Task Force's 2019 PrEP recommendations, with one difference. The USPSTF now includes tenofovir alafenamide/emtricitabine (Descovy) and cabotegravir (Apretude) — new oral and injectable PrEP formulations.

The recommendations also define which drugs should be used in specific situations. Specifically, for adults and adolescents at risk of sexually acquired HIV weighing at least 77 pounds, physicians can prescribe oral tenofovir disoproxil fumarate/emtricitabine (Truvada) or injectable Apretude.

In addition, physicians can prescribe oral Descovy similarly, but not for people at risk from receptive vaginal sex.

However, the FDA has not approved any PrEP drugs to reduce the risk of acquiring HIV through injection drug use. Still, the USPSTF says people who inject drugs may benefit from any PrEP medications, per CDC guidelines.

In addition to PrEP, the USPSTF recommends behavioral counseling to help reduce the risk of STIs and discuss HIV screening.

The USPSTF is independent of the U.S. government, including the Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services. Still, physicians and health officials consider its recommendations when treating patients or developing public health policies.

However, the ongoing case of Braidwood Management v. Becerra currently threatens to hamper insurance coverage of PrEP and other free and preventative services under the Affordable Care Act that were recommended by the USPSTF after 2010. Still, a recent 5th U.S. Circuit Court of Appeals ruling preserved these services for now.