1. Wallis, Laura


Preexposure prophylaxis may be effective in highly motivated patients.


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Each year in the United States about 50,000 people are infected with HIV. Although the rate of transmission has declined or leveled out in some groups, it continues to climb in certain high-risk populations. Although HIV is now considered by many to be a chronic illness rather than an automatic death sentence, preventing a disease is always preferable to needing to treat it. And health care providers hoping to prevent HIV transmission in their high-risk patients now have a new line of defense. In a clinical practice guideline released this spring, the Centers for Disease Control and Prevention (CDC) recommended daily use of oral, preexposure antiretroviral prophylaxis-specifically, a combination of tenofovir and emtricitabine, marketed under the trade name Truvada-to reduce the risk of HIV transmission in high-risk adults.

Figure. Marc-Andr Le... - Click to enlarge in new windowFigure. Marc-Andre LeBlanc takes his first dose of Truvada as preexposure prophylaxis for HIV. Photo (C)

Truvada received Food and Drug Administration approval for preexposure HIV prophylaxis in July 2012. After extensive review of the published literature on the safety and efficacy of the combination, the CDC has recommended its use in sexually active men who have sex with men and in heterosexually active men and women at substantial risk for HIV infection (in both cases, those who have HIV-positive sexual partners, a high number of sex partners, a history of inconsistent or no condom use, a recent bacterial sexually transmitted infection, or a history of commercial sex work), as well as in adult injection-drug users with HIV-positive injecting partners or who share injection equipment. It's also of potential benefit to heterosexual HIV-discordant couples (couples in which one partner is HIV positive) who want protection during conception and pregnancy.


"Nurses need to be aware that this exists because we're pushing combination prevention," says Lucy Bradley-Springer, associate professor at the University of Colorado Denver School of Medicine and editor of the Journal of the Association of Nurses in AIDS Care. "No one method works all the time, so if you combine a variety of methods, you have a better chance of decreasing risk."


Consistent use is essential for efficacy; Bradley-Springer points out that cost and adverse effects may present barriers to Truvada use in some patients, so highly motivated patients will do best on the regimen. "It's easy to take-only one pill a day-but not everybody can keep up with that or with appropriate follow-up," she says.


Patients must have documentation proving a negative HIV test and no signs or symptoms of HIV infection before Truvada is prescribed and keep follow-up visits, which include HIV testing every three months thereafter. The guideline emphasizes that the two-drug regimen is not only inadequate for treatment of established infection, it might also create resistance to either or both drugs; it's essential, therefore, that those testing positive for HIV not continue taking the drug. Clinicians are also urged to monitor patients' renal function during use and to provide counseling on other risk-reducing behaviors, such as regular condom use.


"I've always said that all nurses are HIV nurses," says Bradley-Springer. "This is a chronic disease, and any patient a nurse is caring for could become infected. Nurses need to know about all of the prevention methods."


For further details on preexposure prophylaxis and adherence counseling, CDC guidance is available at For information on how eligible, HIV-negative U.S. adults who don't have insurance can obtain the drug through a medication assistance program, visit Wallis