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JAMA Patient Page
June 11, 2019

Can HIV Infection Be Prevented With Medication?

JAMA. 2019;321(22):2252. doi:10.1001/jama.2019.7149

The US Preventive Services Task Force (USPSTF) recently published recommendations on preventing HIV infection with antiviral medications, also known as preexposure prophylaxis (PrEP).

What Is HIV?

Human immunodeficiency virus (HIV) is a virus that weakens the immune system and decreases the body’s ability to fight infections. It is mainly sexually transmitted but can also be spread via blood (sharing needles or syringes) or from mother to child during pregnancy, birth, or breastfeeding. Infection with HIV produces a wide range of symptoms ranging from flu-like symptoms with initial infection to no symptoms in the early years following infection and to severe infections affecting all organs in the body in the late stage, when the immune system is at its weakest (progression to AIDS). There is no cure for HIV infection, but current antiviral medications are effective at keeping the virus inactive in the body.

What Is PrEP?

Some individuals have a higher chance of becoming infected with HIV than others. Prevention of HIV infection is centered around practicing safer sex (for example, consistent condom use). Antiviral medications can further reduce the chance of HIV infection and are a good option for some people. With PrEP, the same medications that are used to treat HIV infection are used to prevent it. Currently in the United States, a combination pill containing tenofovir plus emtricitabine is the only medication approved by the US Food and Drug Administration for PrEP.

What Is the Patient Population Under Consideration for PrEP?

This USPSTF recommendation applies to individuals who are not infected with HIV and who are at higher risk of HIV infection. These include

  • Individuals who do not have HIV who have a sex partner with HIV

  • Individuals (heterosexual, bisexual, or gay men) with 1 or more sex partners who are at high risk of HIV infection and who do not consistently use condoms

  • Individuals who use injection drugs

  • Commercial sex workers

What Are the Potential Benefits and Harms of PrEP?

There is evidence from randomized trials that PrEP is effective in decreasing the risk of HIV infection in high-risk individuals. A major reason for the variability in how well PrEP works is the variability in adherence to taking the medication daily. Adherence to PrEP is crucial for it to be successful. Potential harms of PrEP include side effects from the medications, which mainly affect the kidneys and gastrointestinal tract but are generally mild and reversible. There is some concern that PrEP may increase the spread of other sexually transmitted infections by decreasing condom use.

How Strong Is the Recommendation for PrEP?

Based on current evidence, the USPSTF concludes with high certainty that the magnitude of benefit of PrEP with tenofovir-based therapy for people at high risk of HIV infection is substantial.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force recommendation statement [published June 11, 2019]. JAMA. doi:10.1001/jama.2019.6390

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