Virus World

It is now recommended that doctors offer a simple pill taken every day -- "pre-exposure prophylaxis" or PrEP -- to people at high risk of acquiring HIV, the life-long viral infection that attacks the body's immune system. The Recommendation Statement is extremely timely, given a national initiative to end the HIV epidemic, and the accompanying evidence report shows PrEP to be both safe and highly effective in preventing HIV acquisition. The USPSTF is, again, deliberate in making its recommendation; PrEP, with the pill combining tenofovir disoproxil fumarate and emtricitabine, was approved by the US Food and Drug Administration in 2012 and first recommended by the Centers for Disease Control and Prevention in 2014. Although uptake of this prevention strategy has been increasing in the United States, implementation challenges remain, driven in part by cost and access. Currently, less than 10% of individuals with an indication for PrEP are receiving this medication. The task force Recommendation Statement also notes that PrEP, in some trials, has been completely effective in preventing HIV infection, but only if medication adherence is continuously high. Adherence support from clinical and nonclinical staff—the Achilles heel of PrEP success—is essential, but especially for youth and women among whom adherence has been low.