New CDC estimates underscore the need to increase awareness of a daily pill that can prevent HIV infection – Press Release

On November 24, 2015, the Centers for Disease Control and Prevention (CDC) released a Vital Signs report indicating that a significant number of adults in the United States are at substantial risk for HIV infection and should be counseled on the use of Pre-Exposure Prophylaxis, commonly known as PrEP.

The report estimated that 25 percent of sexually active gay and bisexual adult men and nearly 20 percent of adults who inject drugs are at a high enough risk to warrant PrEP. In contrast, the report found that less than 1 percent of heterosexually active adults fall into this high-risk category.

PrEP is a daily medication designed for individuals who are HIV-negative but have a high likelihood of exposure to the virus. When taken as prescribed, the medication reduces the risk of getting HIV from sex or injection drug use.

The CDC’s findings underscore a critical gap in public health awareness. While the medical tools to prevent HIV infection have advanced, the report suggests that many individuals who could benefit from these interventions are not being identified or counseled by healthcare providers.

The Vital Signs report is part of a series of CDC publications intended to highlight urgent public health problems and provide actionable guidance to clinicians and policymakers to improve health outcomes.

By quantifying the percentage of the population at substantial risk, the CDC aimed to prompt healthcare providers to initiate conversations about PrEP with patients who meet specific risk criteria.

PrEP typically consists of a combination of antiretroviral medications. These drugs work by blocking the virus from establishing an infection in the body if the person is exposed to HIV.

Medical guidelines emphasize that PrEP is not a substitute for other prevention methods. The CDC notes that PrEP does not protect against other sexually transmitted infections (STIs), and the use of condoms remains a recommended strategy for overall sexual health.

The implementation of PrEP requires a rigorous clinical process to ensure patient safety and drug efficacy. Before starting the regimen, a person must be confirmed as HIV-negative through a verified test.

Starting PrEP in an individual who is already living with HIV, even if they are unaware of their status, can lead to the development of drug-resistant strains of the virus. This makes future treatment of the infection more difficult.

Clinical management of PrEP also includes regular monitoring. Healthcare providers typically require kidney function tests and HIV testing every three months to ensure the medication is being tolerated and that the patient remains negative for the virus.

The CDC identifies several factors that contribute to a substantial risk of HIV infection, which informs who should be counseled on PrEP. These factors include:

• Having a partner who is HIV-positive.
• Having a history of sexually transmitted infections, such as syphilis or gonorrhea.
• Engaging in multiple sexual partnerships without consistent condom use.
• Sharing needles or other equipment used for injecting drugs.

The disparity in risk levels highlighted in the report—with gay and bisexual men and people who inject drugs facing much higher percentages of substantial risk—reflects broader epidemiological trends in HIV transmission.

Public health experts emphasize that increasing the uptake of PrEP among these high-risk groups is a key component of the broader strategy to end the HIV epidemic.

Beyond PrEP, the CDC also monitors Post-Exposure Prophylaxis, or PEP. While PrEP is a daily preventative for those at ongoing risk, PEP is an emergency medication taken after a potential exposure to HIV to prevent the virus from taking hold.

The 2015 report serves as a call to action for the medical community to move beyond passive screening and instead actively identify candidates for PrEP through targeted risk assessments.

Increasing the number of people who use PrEP is expected to lower the overall community viral load, contributing to a reduction in new infections across diverse populations.