What is PrEP?
The term Pre-Exposure Prophylaxis (PrEP) refers to an HIV prevention concept in which persons not infected with HIV who are at high risk of the disease are take antiretroviral medication in an attempt to lower their chances of becoming infected if they are exposed to HIV.
Oral PrEP is highly effective in preventing HIV transmission. According to the CDC, daily oral PrEP reduces the risk of getting HIV during vaginal or anal sex by more than 90%. It reduces the risk of transmission through shared intravenous needles by more than 70%.
Learn more at https://www.cdc.gov/hiv/basics/prep.html.
Background
Since 2010, a multitude of studies have indicated the potential of PrEP for prevention among varios populations at high risk for the diease. For more information about these studies, visit our Provider Resources Section, and view the Providers PrEP page in our Clinical Topics Library.
In 2011, the CDC released interim guidance for physicians electing to prescribe PrEP among men who have sex with men (MSM).
On July 16, 2012 the FDA approved the first drug indicated for PrEP use in the United States. Following that approval, on August 10, 2012, the CDC released interim guidance for clinicians considering the use of PrEP for preventing HIV infection in their heterosexually active patients.
The CDC released Final Guidelines for prescribers in May of 2014.
PrEP Policy Issues:
PrEP is a subject for policy debate in HIV care due to concerns about the ability for the already strained U.S. health systems to provide for widespread PrEP use. Public programs such as Medicaid and ADAP have faced significant budget constraints in recent years, and left some HIV patients without the ability to access their medications. There is some concern over the proper balance between coverage of medication regimens for those who are not infected with the disease, with the need to provide access to medication for those who are currently infected.
Another subject of debate has to do with concerns expressed by some scientists about the potential for viral resistance to develop as a result of widespread PrEP use among uninfected individuals. Viral resistance has been seen in many diseases in recent years, including STDs such as gonorrhea. As with all possability of viral resistance the concern is about the possible loss of a treatment option that is currently known to be effective against the disease. However, at the present these concerns have not been substantiated in any way.
The most serious current public policy issue in this area, however, is the major disparities in PrEP uptake by gender and color. CDC data presented in 2018 shows that, of all individuals who could benefit from PrEP in the US, 43.7% were African American, 24.7% Latino and 26.5% white. Data show, however, that “14% of white persons with a PrEP indication having received PrEP in 2015 to 2016, and only 1% of African Americans and 3% Latinos with a PrEP indication had been on PrEP.” Uptake among women, especially women of color, has also been disproportionally low.