Panel Discussion

Men who have sex with men remain the largest segment of the US population at risk for HIV infection. Despite expanded HIV testing, community-based behavioral interventions to reduce risk behaviors, promotion of condom use, increased detection and treatment of other sexually transmitted diseases such as syphilis, gonorrhea and chlamydia, and mental health counseling to address substance abuse, new HIV infections among MSM have continued to increase since the mid-1990s. Pre-exposure prophylaxis (PrEP) is a unique approach to HIV prevention in which antiretroviral drugs are used by HIV-uninfected individuals prior to a potential HIV exposure. PrEP is distinct from post-exposure prophylaxis (PEP), where an individual takes ARV medication promptly after a possible HIV exposure to avoid infection. The Pre-Exposure Prophylaxis Initiative (iPrEX), an international, randomized, double-blind, placebo-controlled phase III clinical trial was conducted to evaluate the efficacy of daily oral use of TDF (tenofovir disoproxil fumarate) and FTC (emtricitabine) among 2,499 HIV- uninfected men and 29 transgendered men who reported engaging in high-risk sexual behaviors with other men within the preceding 6 months. Results of this trial were published in the New England Journal of Medicine in November 2010. Briefly, there was a significant reduction of HIV infection, which increased with higher adherence rates among study subjects who received the active drug compared to those who received the placebo. Based on these findings, the CDC published interim guidelines for PrEP use among MSM in the January 28, 2011 issue of MMWR. PrEP may be an effective prevention strategy for MSM with high risk for HIV infection where alternative strategies have failed to be effective. A comprehensive implementation plan for the clinical use of PrEP will be forthcoming by the CDC in late 2011.

Session Objectives: Describe in full detail the iPrEX study methodology and results Discuss the clinical feasibility and acceptability of PrEP use among HIV-uninfected MSM who seek prevention services at LGBT community healthcare centers; Evaluate the integration of successful implementation of PrEP within the National HIV/AIDS Strategy

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH) , Masters Certified Health Education Specialist (MCHES)