HIV Preexposure Prophylaxis Clinical Practice Guidelines (USPSTF, 2019)

US Preventive Services Task Force (USPSTF)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 30, 2019

The US Preventive Services Task Force (USPSTF) issued a statement on June 11, 2019, recommending offering preexposure prophylaxis (PrEP) for HIV infection to persons at high risk for infection.[1]

The PrEP recommendation also means that private insurers will be required to cover the cost of PrEP drugs, according to rules established by the Affordable Care Act.

Individuals at risk of HIV infection include men who have sex with men (MSM), individuals who are at risk because of heterosexual contact, and individuals who inject drugs. Certain risk factors or behaviors can further increase the likelihood of infection.

Risk Assessment

MSM who are sexually active and meet at least one of the following criteria should be considered for PrEP:

  • Is in a sexual relationship with a partner who has HIV infection

  • Reports inconsistent condom use during anal sex (receptive or insertive)

  • Has had a sexually transmitted infection (STI; syphilis, gonorrhea, or chlamydia) within the preceding six months

Heterosexually active men and women who meet one of the following criteria should be considered for PrEP:

  • Is in a sexual relationship with a partner who has HIV infection

  • Reports inconsistent condom use during sex with a partner of unknown HIV status who is considered to be at high risk (eg, a man who has sex with men and women or an individual who injects drugs)

  • Has had an STI (syphilis or gonorrhea) within the preceding 6 months

Individuals who inject drugs and meet one of the following criteria should be considered for PreP:

  • Shares drug injection equipment

  • Is at risk of sexual HIV acquisition

Another group at high risk of HIV infection are individuals who engage in transactional sex (eg, for money, drugs, or housing), including commercial sex workers or persons trafficked for sex work. They should also be considered for PrEP based on the above criteria.

Preventive Medication

Combined tenofovir disoproxil fumarate and emtricitabine administered orally once a day is the only formulation of PrEP that is FDA-approved in the United States for use in persons at risk of sexually transmitted HIV infection.

For more information, please go to Preexposure HIV Prophylaxis.

For more Clinical Practice Guidelines, please go to Guidelines.

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