Evidence shows a substantial reduction in HIV transmission among patients receiving a daily combination of tenofovir and emtricitabine. As such, the U.S. Public Health Service recently recommended that physicians offer this daily combo as preexposure prophylaxis (PrEP) to patients at high risk for HIV infection, including nonmonogamous men who have sex with men, serodiscordant couples, heterosexual men and women in other risk groups, and injection drug users.
While the guidelines are clear, their application in clinical practice might present challenges based on individual patient characteristics. A multicomponent article published in Annals of Internal Medicine goes 'Beyond the Guidelines' to debate the use of PrEP in a 45-year old man whose husband has HIV infection with an undetectable viral load on treatment.
Two prominent HIV experts 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. The patient shares his story in text and on video and explains how his husband's diagnosis affects their relationship both before and after starting PrEP.
All 'Beyond the Guidelines' papers are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center in Boston. A list of topics and related videos are available at http://www.annals.org/grandrounds.