Great fanfare has accompanied the findings from several big studies over the past few years that an anti-HIV pill a day can keep the virus away. Interim guidelines from the U.S. Centers for Disease and Prevention have backed the approach, known as pre-exposure prophylaxis (PrEP), for people at high risk of becoming infected, and the U.S. Food and Drug Administration also approved the strategy in 2012. But PrEP has not had much traction with young gay men, one of the highest at-risk groups in the United States and elsewhere. And the number of new infections per year in the United States stubbornly has remained at about 50,000 people for more than a decade.
Now, the U.S. Public Health Service has issued finalized clinical guidelines that it hopes will lead to much more widespread use of PrEP, much in the same way that many take statins to reduce the risk of heart disease. The guidelines recommend daily use of the drug Truvada—which combines two antiretrovirals—for sexually active men who have sex with men, heterosexuals “at substantial risk” of infection” (including those who have an HIV-infected partner), and people who inject drugs. Although daily Truvada doses cost about $13,000 per year, insurance plans typically cover the expense. The company that manufactures Truvada, Gilead Sciences Inc. of Foster City, California, also assists uninsured people.