Eileen E. Reynolds, MD; Howard Libman, MD (*); Kenneth H. Mayer, MD (*)
Acknowledgment: The authors thank the patient for sharing his story.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Dr. Mayer has received unrestricted research grants from Gilead Sciences, Merck, and Bristol-Myers Squibb. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1993.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Eileen E. Reynolds, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, email@example.com.
Current Author Addresses: Drs. Reynolds, Libman, and Mayer: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
The U.S. Public Health Service recently issued guidelines about the daily use of medication as preexposure prophylaxis (PrEP) to prevent HIV infection. The guidelines, based on randomized trials showing substantial reduction in HIV transmission among those receiving a daily combination of tenofovir and emtricitabine, suggest physicians offer PrEP to patients at high risk, including nonmonogamous men who have sex with men, serodiscordant couples (in both male–male and male–female relationships), heterosexual men and women in other risk groups (such as sex workers or those with recent sexually transmitted infection), and injection drug users. Here, 2 prominent HIV experts debate the use of PrEP in a 45-year-old man whose husband has HIV infection with an undetectable viral load on treatment. They discuss the patient's risk for HIV transmission from his husband and from other partners, the magnitude of the risk reduction he would gain with PrEP, and
nonpharmacologic alternatives to reduce his likelihood of contracting HIV infection.
Eileen E. Reynolds, Howard Libman, Kenneth H. Mayer. Preexposure Prophylaxis for HIV Prevention: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2015;163:941–948. doi: 10.7326/M15-1993
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Published: Ann Intern Med. 2015;163(12):941-948.
HIV, Infectious Disease, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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