Review the updated 2023 United States Preventive Task Force (USPSTF) guidelines on PrEP for HIV Prevention with Dr. John Wong.
HIV remains an important health concern across the globe. In 2020, there were over 30,000 new cases of HIV diagnosed in the United States (CDC 2022). There are 1.2 million individuals living with HIV in the United States (CDC 2019). It is estimated that 1 in 7 of individuals with HIV are unaware of their infection (KFF 2023). The USPSTF recommends screening for HIV in those between the ages of 15 and 65, as well as in anyone who is at increased risk, and in all pregnant persons (USPSTF 2019).
The USPSTF recommends that clinicians prescribe preexposure prophylaxis (PrEP) using effective antiretroviral therapy to persons who are at increased risk of HIV acquisition to decrease the risk of acquiring HIV.
PrEP stands for pre-exposure prophylaxis. It involves taking medication to prevent getting HIV infection. The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons who are at increased risk of HIV acquisition to decrease the risk of acquiring HIV.
There are two oral versions and an injectable form. Both forms of medication are safe and effective, but now prescribers have additional options that can be more appropriately tailored to patient preferences and lifestyle. The oral options are emtricitabine/tenofovir disoproxil fumarate, abbreviated as TDF-FTC, brand name: Truvada and emtricitabine/tenofovir alafenamide, abbreviated as TAF-FTC, brand name: Descovy. The injection version is cabotegravir extended-release suspension, brand name: Apretude. Patients must weigh at least 77lb (35kg) to receive PrEP. TAF-FTC (Descovy) is not approved for recipients of vaginal sex.
Prior to initiation, patients should receive testing for HIV (USPSTF 2023). If they have received oral PrEP or post-exposure prophylaxis in the past 3 months, or a cabotegravir injection in the past 12 months, they should be tested with an HIV antigen-antibody assay as well as HIV-1 RNA assay. If they have not, an HIV antigen-antibody assay is sufficient (CDC 2021). Other tests including baseline kidney function and hepatitis B serologies should be obtained as well in PrEP containing tenofovir (TDF/FTC or TAF/FTC)(USPSTF 2023). It is also recommended that testing for other STIs and pregnancy testing (when appropriate) be conducted prior to initiating PrEP
and lipid profile testing is recommended prior to initiating TAF/FTC. Patients receiving PrEP should be screened every 2-3 months for HIV and at regular intervals for other STIs based upon their individual risk factors (USPSTF 2023). Pharmacokinetic data suggests PrEP with TDF-FTC reaches its maximum concentrations in peripheral blood and rectal tissue after 7 days, and in cervicovaginal tissue after 20 days (USPSTF 2023, CDC 2021).
Listeners will review the updated USPSTF guidelines on PrEP.
After listening to this episode listeners will…
Dr. Wong reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Garbitelli BC, Wong J, Williams PN, Watto MF. “#417 USPSTF Update: PrEP for HIV Prevention with Dr. John Wong”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast November 22, 2023.
Producer, Writer, Show Notes, Infographic/Cover Art: Beth Garbitelli MD
Hosts: Paul Williams MD, FACP, Beth Garbitelli MD
Reviewer:Leah Witt MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: John Wong MD
Got feedback? Suggest a Curbsiders topic. Recommend a guest. Tell us what you think.
We love hearing from you.
Yes, you can now join our exclusive community of core faculty at Kashlak Memorial Hospital along with all the perks:
Close this notice to consent.