Like It or Not, PrEP Enters the Clinic

March 11, 2011

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

Since the publication of iPrEx, the hypothetical decision about whether to prescribe pre-exposure prophylaxis (PrEP) has become a practical reality.

As a result, we've posted a case on the Journal Watch/AIDS Clinical Care site, describing someone who requests intermittent pre-exposure prophylaxis to prevent HIV.

It's a high-risk, HIV-negative man who's been treated several times with post-exposure prophylaxis. The case was adapted from someone seen recently in our practice, and it raised many questions about what to do in this newly minted area. As there are obviously no "right" answers, we had a broad range of responses within our group. We've asked experts in the field to weigh in as well and will publish those responses shortly.

In the meantime, what have you been doing with requests for PrEP? Have you found the "Guidance" (note that these are not yet "Guidelines") useful? Any helpful or just interesting anecdotes or opinions you wish to share?

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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NEJM Journal Watch is a publication of the Massachusetts Medical Society.

Reader Comments:

Comment by: David Y (Des Moines, Iowa) Tue., Mar. 22, 2011 at 10:09 am UTC
I am waiting for one of our discordant couples to inquire about using PrEP while trying to conceive.
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Replies to this comment:
Comment by: Bethsheba (Dallas, TX) Tue., Jul. 12, 2011 at 9:21 pm UTC
Our clinic had one today....a patient inquiring about PrEP for his seronegative wife in regards to prevention and contraception.

Comment by: Bethsheba Johnson (Dallas, TX) Thu., Mar. 17, 2011 at 11:51 am UTC
We need more data on long-term efficacy and potential for resistance. Also we need an infrastructure to support the guidance. Who will pay for non-insured persons?
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