CDC
in November when the researchers revealed positive results of the first large-scale trial of anti-HIV drugs to prevent the sexual transmission of virus, a barrage of questions immediately surfaced on how best to use what is called pre-exposure prophylaxis (PrEP). Today, the US Centers for Disease Control and Prevention (CDC) published the first recommendations to health care providers about PrEP. Although the "interim guidance" a few surprises and is only a temporary solution until the US Public Health Service issues more formal recommendations, clinicians are welcoming the entry. "It is an important step in the development of recommendations," said Robert Grant, a virologist with the J. Gladstone Institutes of the University of California, San Francisco (UCSF), who led the positive PrEP trial.
the study, reported online November 23 in the New England Journal of medicine , found that daily use of two anti-HIV drugs combined into one pill called Truvada reduced the risk of transmission in men and uninfected women transgender who have sex with men 44%. the efficiency jumped to 73% in a subset of participants who reported taking their pills every day at least 0 % of the time, indicating that prevention was closely linked to the respect of the testing protocol. the results received reports of widespread media and have been recognized by scientists worldwide as a significant advance in the field of prevention HIV tired failure.
Grant and his colleagues pointed out at the outset that the results apply only to this population, and interim CDC guidance repeats this warning. It also recommends that clinicians carefully test patients for HIV infection before prescribing Truvada as a preventive and follow up with tests every 2 to 3 months. CDC suggests the same dosage, the board and the daily supply of condoms as used in the study and said requirements should be 0 days, which would give clinicians a formal way to periodically confirm that their patients are still negative. (In people with HIV, Truvada is used only in combination with other antiretroviral drugs to prevent the emergence of resistant strains of the virus drugs.)
CDC said it has published guidelines provisional because of concerns that "dangerous and potentially less effective PrEP practices could develop" before final recommendations are made as Truvada is already an approved drug for the treatment and HIV clinicians already prescribe its off-label use preventively . specifically, the CDC said he wanted to discourage clinicians prescribe other anti-HIV drugs as PrEP, using a dosing schedule other than the one proven to work in the study, supply orders without advice and condoms, not properly test and monitor patients for HIV infection.
the guide says it will take "several months" for PHS to issue further recommendations, as now is the collection "of expert and public input."
Davey Smith, an HIV / AIDS clinician at UC San Diego, said one outstanding issue is cost. "The main hold-up is going to be who will pay for it," says Smith. "It is also the lowest socioeconomic gays men who have already burden. They are the neediest of the needy, and they are those who do not have access to health care. I do not think we've been very good to think about the other side of the coin. "
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