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HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

Educational Objective
To summarize current guidelines and expert recommendations to increase adoption of HIV preexposure prophylaxis (PrEP) prescribing activities by frontline primary care clinicians.
1 Credit CME

A global human immunodeficiency virus (HIV) epidemic persists despite data to support multiple effective and safe tools that prevent HIV transmission and acquisition. Human immunodeficiency virus preexposure prophylaxis (PrEP) for HIV-uninfected at-risk populations using tenofovir disoproxil fumarate emtricitabine is highly effective, safe, and recently endorsed by the US Preventive Services Task Force (USPSTF) as a grade A recommendation. In this Special Communication, we summarize current guidelines and expert recommendations in a call for wider adoption of PrEP prescribing activities by frontline primary care clinicians. Key components include the ideal contexts in which PrEP may be prescribed, eligibility criteria, clinical considerations and pitfalls, laboratory monitoring, prescription practices, situations that may warrant expert consultation, and future directions. Given the broad scope, access, and point-of-entry status of primary clinicians in health systems, generalists will need to be at the center of any successful effort to leverage the power of, and destigmatize PrEP to end the HIV epidemic.

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Article Information

Corresponding Author: Raphael J. Landovitz, MD, MSc, Center for Clinical AIDS Research and Education, University of California, Los Angeles, 11075 Santa Monica Blvd, Ste 100, Los Angeles, CA 90025 (rlandovitz@mednet.ucla.edu).

Accepted for Publication: September 20, 2019.

Published Online: November 18, 2019. doi:10.1001/jamainternmed.2019.5456

Author Contributions: All authors had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Drafting of the manuscript: Khalili.

Critical revision of the manuscript for important intellectual content: Landovitz.

Administrative, technical, or material support: Landovitz.

Study supervision: Landovitz.

Conflict of Interest Disclosures: Dr Landovitz reported personal fees from Gilead Sciences and Merck Sharp & Dohme during the conduct of the study. No other disclosures were reported.

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