Investing in People Who Inject Drugs: A PrEPonderance of Opportunities
Authors: Rochelle P. Walensky
Journal: Annals of Internal Medicine (2016)

Editorials5 July 2016Investing in People Who Inject Drugs: A PrEPonderance of OpportunitiesRochelle P. Walensky, MD, MPHRochelle P. Walensky, MD, MPHFrom Massachusetts General Hospital, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0788 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2014, with more than 10 randomized efficacy trials on preexposure prophylaxis (PrEP), the Centers for Disease Control and Prevention (CDC) published clinical practice guidelines on the use of PrEP for high-risk individuals. Citing the Bangkok Tenofovir Study (1), which reported a 49% reduction in HIV incidence (PrEP efficacy) among people who inject drugs (PWID), the CDC recommended PrEP as “one prevention option for adult injection drug users at substantial risk of HIV acquisition” (2).In Annals, a respected, widely published team of HIV-simulation modelers examines the following questions of PrEP for PWID: What is the public health benefit? Is ...References1. Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al; Bangkok Tenofovir Study Group. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083-90. [PMID: 23769234] doi:10.1016/S0140-6736(13)61127-7 CrossrefMedlineGoogle Scholar2. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. Accessed at www.cdc.gov/hiv/pdf/prepguidelines2014.pdf on 4 April 2016. Google Scholar3. Bernard CL, Brandeau ML, Humphreys K, Bendavid E, Holodniy M, Weyant C, et al. Cost-effectiveness of HIV preexposure prophylaxis for people who inject drugs in the United States. Ann Intern Med. 2016;165:10-9. doi:10.7326/M15-2634 LinkGoogle Scholar4. Indiana State Department of Health. Indiana State Department of Health investigates additional HIV cases tied to Southeastern Indiana outbreak [news release]. 28 August 2015. Accessed at www.in.gov/isdh/files/August_28_ISDH__Investigates_Additional_HIV_Cases_Tied_To_Southeastern_Indiana_Outbreak.pdf on 4 April 2016. Google Scholar5. Adams LM, Balderson BH. HIV providers' likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: a short report. AIDS Care. 2016:1-5. [PMID: 26915281] MedlineGoogle Scholar6. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. HIV Surveillance—Epidemiology of HIV Infection (through 2014). Atlanta, GA: Centers for Disease Control and Prevention; 2013. Accessed at www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-genepi.pdf on 4 April 2016. Google Scholar7. Behavioral Health Coordinating Committee Prescription Drug Abuse Subcommittee. Addressing prescription drug abuse in the United States: current activities and future opportunities. Washington, DC: U.S. Department of Health and Human Services; 2013. Google Scholar8. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65:1-49. [PMID: 26987082] doi:10.15585/mmwr.rr6501e1. Accessed at www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm on 4 April 2016. Google Scholar9. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158:1-9. [PMID: 23277895]. doi:10.7326/0003-4819-158-1-201301010-00003 LinkGoogle Scholar10. Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014;43:235-48. [PMID: 24374889] doi:10.1093/ije/dyt243 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Massachusetts General Hospital, Boston, Massachusetts.Acknowledgment: The author thanks Drs. Paul E. Sax and Edward H. Bersoff for critical review of the manuscript and Ethan Borre for technical assistance.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0788.Corresponding Author: Rochelle P. Walensky, MD, MPH, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, [email protected]org.This article was published at www.annals.org on 26 April 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States Cora L. Bernard , Margaret L. Brandeau , Keith Humphreys , Eran Bendavid , Mark Holodniy , Christopher Weyant , Douglas K. Owens , and Jeremy D. Goldhaber-Fiebert Metrics Cited byCommentary: the value of PrEP for people who inject drugsGlobal implementation of PrEP as part of combination HIV prevention - Unsolved challenges 5 July 2016Volume 165, Issue 1Page: 63-64KeywordsDrugsHIVHIV infectionsHIV preventionOpiatesOpioid addictionOpioidsPreexposure prophylaxisPrevention, policy, and public healthQuality adjusted life years ePublished: 3 May 2016 Issue Published: 5 July 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...