CDC Recommends a Prophylactic Pill for HIV

Preexposure prophylaxis (PrEP) is an infection control strategy meant to prevent the spread of disease using antiviral drugs in at-risk populations. The CDC has issued a recommendation for the use of daily oral antiretroviral PrEP to reduce the risk of acquiring HIV infection in adults. The guideline recommends:

1. Use of daily oral PrEP (a fixed-dose combination tablet of 300 mg tenofovir disoproxil fumarate [TDF] and 200 mg emtricitabine [FTC]) in sexually active adult men who have sex with men, in at-risk adult men and women, in at-risk adult injectable drug users, and as an option for the sexual partners of HIVinfected individuals.

2. Due to a lack of sufficient data, the decision to use PrEP in adolescents should be weighed carefully prior to initiation.

3. Before initiating PrEP therapy in a patient, the possibility of acute and chronic HIV infection must be excluded.

4. Truvada (Gilead Sciences, Inc) is the only FDA-approved regimen for PrEP.

5. Patients using PrEP should be screened for HIV infection every 3 months, and those with an incident HIV infection should discontinue use of PrEP.

6. Patient renal function should be monitored.

7. Risk-reduction services and medication adherence should be encouraged.¹

EBIID

Although Truvada was approved by the FDA back in 2012 for reducing the risk of sexual transmission of HIV infection,² the recent CDC recommendation for broader testing has rekindled the debate on insurance coverage for the drug. Estimated to cost between $8000 and $14,000 annually,^3,4 most health plans will cover preventive drugs without patient cost-sharing only following a recommendation by the US Preventive Services Task Force (USPSTF). Although Truvada use is not yet recommended for prevention of HIV by the USPSTF,⁵ the AIDS.gov website states that most insurance programs do provide coverage for the drug.⁶