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Special Communication
November 18, 2019

HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

Author Affiliations
  • 1Center for Clinical AIDS Research and Education, David Geffen School of Medicine, Department of Medicine, University of California, Los Angeles
  • 2Center for Clinical AIDS Research and Education, David Geffen School of Medicine, Division of Infectious Diseases, University of California, Los Angeles
JAMA Intern Med. 2020;180(1):126-130. doi:10.1001/jamainternmed.2019.5456

A global human immunodeficiency virus (HIV) epidemic persists despite data to support multiple effective and safe tools that prevent HIV transmission and acquisition. Human immunodeficiency virus preexposure prophylaxis (PrEP) for HIV-uninfected at-risk populations using tenofovir disoproxil fumarate emtricitabine is highly effective, safe, and recently endorsed by the US Preventive Services Task Force (USPSTF) as a grade A recommendation. In this Special Communication, we summarize current guidelines and expert recommendations in a call for wider adoption of PrEP prescribing activities by frontline primary care clinicians. Key components include the ideal contexts in which PrEP may be prescribed, eligibility criteria, clinical considerations and pitfalls, laboratory monitoring, prescription practices, situations that may warrant expert consultation, and future directions. Given the broad scope, access, and point-of-entry status of primary clinicians in health systems, generalists will need to be at the center of any successful effort to leverage the power of, and destigmatize PrEP to end the HIV epidemic.

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    1 Comment for this article
    PrEP for (almost) everyone
    Anthony Glaser, MD, PhD | Paladina Health
    Surely this article should be a little more nuanced. According to the risk assessment, anyone who has condomless sex with one partner should proceed to labs and PrEP prescription. I would suggest that the risk assessment should be just a little more detailed . . . people in monogamous relationships might want a little input into this decision. Has anyone done a cost-benefit analysis of prescribing PrEP for everyone in the US who has sex without condoms?