USPSTF Statement on PReP: Preexposure Prophylaxis for the Prevention of HIV Infection Interview with:

John W. Epling, Jr., M.D., M.S.Ed Professor of Family and Community Medicine Virginia Tech Carilion School of Medicine Roanoke, VA USPSTF Task Force Member

Dr. Epling

John W. Epling, Jr., M.D., M.S.Ed
Professor of Family and Community Medicine
Virginia Tech Carilion School of Medicine
Roanoke, VA
USPSTF Task Force Member
Medical Director of Employee Health and Wellness
Carilion Clinic
Dr. Epling maintains an active clinical primary care practice What is the background for this study?

Response: HIV continues to be a significant public health issue, with about 40,000 people diagnosed each year. The U.S. Preventive Services Task Force reviewed the most recent evidence on how primary care clinicians can best help prevent HIV and its devastating health consequences. We looked at the research on two different topics: screening for HIV, and pre-exposure prophylaxis—a medication that prevents HIV, commonly known as PrEP. What are the main findings of the underlying studies?

Response: The research showed that both screening and PrEP are effective methods accomplish the goals of preventing HIV, achieving early detection and treatment and reduce transmission.As such, the Task Force has published two separate recommendation statements, both of which contain A recommendations. The Task Force recommends HIV screening for people who are 15 to 65 years old, as well as everyone who is pregnant. In addition, patients who do not have HIV but are at high risk of getting it should be offered PrEP. What should readers take away from your report?

Response: While the screening recommendation is consistent with past Task Force guidance, this is the first time the Task Force has reviewed the evidence and published a recommendation for PrEP. We hope that widespread screening and appropriate use of PrEP will help reduce the burden of HIV in the U.S. What recommendations do you have for future research as a result of this work? 

Response: We need better tools to help clinicians identify people at high risk for HIV infection who would benefit from PrEP. It would also be helpful to have more studies on different PrEP drugs and different dosing strategies—fortunately, some of this is already underway.

Additionally, we need to better understand why some people at high risk for HIV don’t take PrEP or why they don’t take it as prescribed. Adherence is vital to the effectiveness of PrEP, and we need to know how best to promote adherence. This is especially needed among adolescents and minority communities.

We need more evidence that includes transgender people so we can better understand PrEP’s effectiveness in this population.

Finally, more research is needed to see if there is a link between taking PrEP and a higher risk of other sexually transmitted infections so that clinicians can counsel patients appropriately. Is there anything else you would like to add?

Response: PrEP is not for everyone—it is for people at high risk of getting HIV. Behaviors that put people at high risk include having sex with a partner who has HIV, not always using condoms when having sex with partners who are at high risk, and sharing injection drug needles. Clinicians can determine who is at high risk for HIV by routinely asking about their adolescent and adult patient’s sexual history and injection drug use For patients whose history shows that he or she may be at risk, clinicians should ask questions to figure out that person’s level of risk and recommend PrEP, if appropriate. 


Preexposure Prophylaxis for the Prevention of HIV Infection US Preventive Services Task Force Recommendation Statement




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