Doctors Get Guidelines for Medicine to Block HIV
January 28, 2011
CDC on Thursday published interim guidelines for providers facing questions about the use of the HIV drugs tenofovir and emtricitabine (TDF/FTC) to prevent sexually acquired HIV infection. In an international trial, TDF/FTC taken orally each day with an adherence rate of at least 90 percent was associated with a 73 percent reduction in risk of HIV infection among men who have sex with men. The MSM in both the treatment and control groups received preventive services, including counseling, condoms, and STD treatment if needed.
While CDC and other US Public Health Service agencies are developing guidelines on the use of TDF/FTC pre-exposure prophylaxis (PrEP), concerns exist about unsafe and potentially less effective PrEP practices that could develop during the interim, CDC said. The agency specifically cited intermittent dosing just before or after sex as a concern. In the trial, MSM who adhered to daily TDF/FTC at less than 90 percent had only a 21 percent reduction in HIV risk, a sharp decline in efficacy.
"PrEP has the potential to contribute to effective and safe HIV prevention for MSM if (1) it is targeted to MSM at high risk for HIV acquisition; (2) it is delivered as part of a comprehensive set of prevention services, including risk-reduction and PrEP medication adherence counseling, ready access to condoms, and diagnosis and treatment of [STDs]; and (3) it is accompanied by monitoring of HIV status, side effects, adherence and risk behaviors at regular intervals," CDC said.
MSM at high risk include those who are not taking other effective risk-reduction measures, such as using condoms; those who have frequent partner changes or concurrent partners in high HIV prevalence settings; and MSM whose sex partners are HIV-positive or of unknown serostatus.
In the San Francisco Bay Area, public health officials could begin a PrEP pilot this summer for men who meet CDC guidelines. The trial would determine how best to deliver PrEP and ensure adherence and condom use.
MSM inquiring about PrEP should first be tested for HIV and other STDs at the outset, CDC noted. For the full set of interim guidelines, visit: www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm.
San Francisco Chronicle
01.28.2011; Erin Allday
Interim Guidance: Pre-Exposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex With Men
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