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  • Broadened Access and First Injectable PrEP
    Research and development in HIV antiviral treatments over the past decade has made it possible to reduce the risk of sexually transmitting HIV by 99%. However, there is still much work to be done in increasing access and availability for the treatments to eligible individuals.

    The new CDC clinical practice guidelines released at the end of 2021 emphasize the importance of and advise clinicians on communicating with all patients, adults and adolescents alike, who are sexually active about pre-exposure prophylaxis (PrEP) to prevent HIV. They also recommend that the therapies be prescribed to any eligible individuals who request them. This broadened recommendation for providers to inform all sexually active adults and adolescents about PrEP is a shift that is intended to reach an increased amount of at-risk individuals. Social stigmas, fears, and other barriers to communicating with health professionals can limit patients gaining knowledge about and access to effective medications such as PrEP. By altering the guideline, support is added that can help encourage additional individuals to seek effective therapies to help protect themselves from HIV.

    Since the telehealth visit landscape has grown substantially over the past few years, statements are included in the updated guidelines covering providing PrEP through telehealth methods. PrEP initiation and follow-up care can be handled through telehealth visits. This type of ease-of-access is another way barriers to care are being reduced. For those seeking further information regarding telehealth and PrEP, the National Alliance of State and Territorial AIDS Directors (NASTAD) provides resources regarding state-specific tele-PrEP services for at-home HIV, HCV, STI, and PrEP self-testing.

    Also new in the updated guidelines are recommendations for the recently approved drug, Apretude (cabotegravir), extended-release injectable suspension. Apretude is the first FDA-approved injectable, long-acting HIV PrEP medication. Apretude is indicated in at-risk adults and adolescents (≥35kg) as PrEP to reduce the risk of sexually acquired HIV-1 infection. Before initiating Apretude, patients must have a negative HIV test. The new injectable therapy has higher efficacy than the existing tablet PrEP options (Truvada [emtricitabine/tenofovir disoproxil fumarate] and Descovy [emtricitabine/tenofovir alafenamide]). It can be a valuable alternative for those who cannot tolerate the other medication types or are more likely to be adherent to a therapy that does not need daily administration. The guidelines provide a recommended dosage of Apretude as 600mg injected into a gluteal muscle every 2 months for PrEP in adults at risk of acquiring HIV.

    Healthcare providers can delve more deeply into the new recommendations, existing guidance, and detailed aspects of clinical care by exploring the full CDC Clinical Practice Guideline update at: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. The guidelines have also been refined to improve usability and increase implementation based on comments from clinicians who provide PrEP care. Beyond this, if clinicians need additional advisement regarding managing patients on PrEP, the National Clinicians Consultation Center has an established hotline, available from 11 am–6 pm ET, at 855-448-7737. Expanding knowledge and resources regarding PrEP can hopefully help make treatment more widely available and bring the healthcare community closer to ending the ongoing HIV epidemic.

    Stay informed about drug information, including medications for PrEP, by updating or registering your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, mobilePDR, available for free from your favorite app stores.