Daily HIV prevention pill urged for healthy people at risk

Mohd Hafiez Mohd Razali  EyeEm—Getty Images  EyeEm

Mohd Hafiez Mohd Razali EyeEm—Getty Images EyeEm

People at high risk of HIV infection include those who inject drugs and those who have sex without condoms when they don't know the HIV status of their high-risk partner.

TUESDAY, June 11, 2019 (HealthDay News) - A daily pill that can block transmission of HIV should be prescribed to people at high risk of infection with the AIDS-causing virus, according to a highly influential panel of experts. USPSTF also recommended screening for adolescents and adults aged 15 to 65 years for HIV infection, as well as screening for younger adolescents and older adults who are at an increased risk, the article reported. According to the article, patients in the study who reached a score of clear or nearly clear on the static Physician Global Assessment (sPGA 0/1) at week 28 were randomized to either continue on risankizumab or placebo.

Best known as the two-drug combo pill Truvada (emtricitabine-tenofovir), the medication prevents HIV from establishing a permanent infection in people exposed through sex or injection drug use, according to the U.S. Centers for Disease Control and Prevention.

The new guidelines aim to help cut the almost 40,000 new HIV infections in the US each year.

"The Recommendation Statement is extremely timely, given a national initiative to end the HIV epidemic, and the accompanying evidence report shows PrEP to be both safe and highly effective in preventing HIV acquisition", wrote Dr. Hyman Scott and Dr. Paul Volberding in an editorial published Tuesday in JAMA.

"We've done a good job in medicine at being able to treat HIV, in the sense it's now become a chronic disease for most people. but we still have a problem with new HIV infections", says John Epling, a physician and professor of family and community medicine at Virginia Tech and a member of the U.S. Preventive Services Task Force.

'The USPSTF also found convincing evidence that adherence to PrEP is highly associated with its efficacy in preventing the acquisition of HIV infection; thus, adherence to PrEP is central to realizing its benefit'.

According to the USPSTF, about 15 percent of people who have HIV don't know they are infected and are responsible for an estimated 40 percent of transmissions in the US.

But obstacles remain. The only U.S. Food and Drug Administration-approved drug for PrEP, Truvada, now costs $20,000 a year, said Dr. Rochelle Walensky, an infectious disease specialist at Massachusetts General Hospital in Boston.

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The recommendations were published in the Journal of the American Medical Association.

"The cost of the medication is absolutely a barrier for a lot of people in the U.S.", Scott said in an interview.

The task force reviewed 14 randomized clinical trials, eight observational studies, and seven studies of diagnostic accuracy to reach its recommendation. The task force assigned an A to the HIV prevention treatment. Another side effect in some people taking Truvada is elevated creatinine, a measure of kidney function, so patients on the drug are monitored periodically.

The U.S. Centers for Disease Control and Prevention has more about pre-exposure prophylaxis.

Men who have sex with other men and are in a relationship with an HIV-positive person; who use condoms inconsistently; or who have had a sexually transmitted disease within the past six months. And the more faithfully people took the daily pills, the higher the likelihood that they would be protected from HIV.

Havlir and Buchbinder have also launched an innovative treatment program that immediately connects people who are diagnosed with HIV to the hospital's treatment clinic and set up with their first dose of anti-HIV pills.

With the task force's "bold" recommendation, "the elusive goal of ending the HIV epidemic in the US now seems possible", Urbina said. "We are not going to bring the incidence of new infections down significantly unless PrEP is maximally utilized".

"I hope that with this recommendation we can garner momentum to bend the curve for new HIV infections in the USA", says Havlir.

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