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
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