Guideline: USPSTF recommends preexposure prophylaxis with antiretroviral therapy for persons at high risk for HIV
Abstract
Guideline scope Preexposure prophylaxis (PrEP) for prevention of HIV infection. Guideline methods The US Preventive Services Task Force (USPSTF) commissioned a systematic review on PrEP for prevention of HIV infection in persons at high risk*. {MEDLINE, EMBASE/Excerpta Medica, Cochrane Library, and reference lists (all to Jun 2018) and article alerts and targeted journals (Jan 2019) were searched for English-language randomized controlled trials (RCTs)}* that evaluated the benefits and harms of PrEP with oral tenofovir disoproxil fumarate monotherapy or tenofovir disoproxil fumarateemtricitabine vs placebo or no PrEP in persons at high risk for HIV. 12 RCTs {n =18244, mean age <40 y in all trials}*, {ranging in size from 72 to 4726 patients}*, met the selection criteria. Persons were at higher risk due to characteristics of their sexual contacts (11 RCTs) or use of injectable drugs (1 RCT). {Comparators were placebo (11 RCTs) or delayed PrEP (1 RCT).}* Follow-up ranged from 4 months to 4 years. 11 trials were rated as good quality, and 1 was fair quality. Diagnostic accuracy of instruments to predict HIV acquisition, rates of PrEP adherence, and the association between PrEP adherence and effectiveness were also reviewed but are not reported here. A draft version of the recommendations was publicly posted for comments. Results and recommendation The USPSTF recommends that PrEP with effective antiretroviral therapy be offered to persons at high risk for HIV (Grade A…
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