Department of Psychology, George Washington University, Washington, DC.
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University.
Clin Infect Dis. 2019 Aug 16;69(5):884-889. doi: 10.1093/cid/ciz046.
Clinical guidelines for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) developed by the US Centers for Disease Control and Prevention have been instrumental in the implementation of PrEP in medical practices throughout the country. However, the eligibility criteria contained within may inadvertently limit PrEP access for some patients. We describe the following key considerations and caveats related to these criteria: promotion of a selective vs universal approach to sexual health education involving PrEP; misalignment between criteria stated in the table and text boxes; problematic categorization and confounding of sexual orientation, gender identity, and risk behavior; underemphasis of network/community-level drivers of HIV transmission; oversimplification of serodiscordant risk; and lack of clarity surrounding the relevance of condoms to PrEP eligibility. We offer concrete recommendations to address the identified issues and strengthen future iterations of the guidelines, applying these recommendations in an alternative table of "criteria."
美国疾病预防控制中心制定的人类免疫缺陷病毒（HIV）暴露前预防（PrEP）临床指南在全国医疗实践中实施 PrEP 方面发挥了重要作用。然而，其中包含的资格标准可能会无意中限制某些患者使用 PrEP。我们描述了与这些标准相关的以下关键考虑因素和注意事项：推广涉及 PrEP 的有选择性的与普遍性的性健康教育培训方法；表格和文本框中规定的标准不一致；性取向、性别认同和风险行为的分类和混淆问题；对 HIV 传播的网络/社区层面驱动因素重视不足；对血清不一致风险的简单化处理；以及围绕避孕套与 PrEP 资格的相关性缺乏明确性。我们提出了具体建议来解决已确定的问题，并加强未来指南的迭代，在一个替代的“标准”表中应用这些建议。
