The Centers for Disease Control and Prevention is making a big push to get more people at "substantial" risk of getting HIV to start on a daily pill that has been shown to dramatically reduce their risk of infection.

Known as PrEP or pre-exposure prophylaxis, the therapy involves taking a daily pill — Truvada — that makes it more difficult for the virus to establish a permanent infection when a person is exposed to it through sexual contact or injectable drug use. Studies have shown that it can reduce risk by 70 to more than 90 percent. In stunning results released in one study in September, researchers found that 100 percent of participants taking HIV prevention pill Truvada remained infection-free for two years. The study, conducted at Kaiser Permanente in San Francisco, involved more than 600 high-risk individuals, most of whom were men who have sex with men.

PrEP is considered to be among the world's most powerful weapons in ending the AIDS epidemic. Despite numerous advances in fighting the disease in recent decades, HIV remains one of the most devastating health issues in the United States. More than 1 million Americans are living with HIV, and more than 40,000 are newly infected each year.

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In September, the World Health Organization radically revised its guidelines for those who should be on HIV anti-retrovirals — greatly expanding the number of those who should be in treatment from 28 million to 37 million.

The CDC has now identified which Americans — a total of 1.2 million — should be counseled about possibly taking the drug, and they include 1 in 4 or 492,000 sexually active gay and bisexual adult men; 1 in 5 or 115,000 adults who inject drugs; and 1 in 200 or 620,000 sexually active straight adults.

The estimates, released Tuesday, draw on data from the National Health and Nutrition Examination Survey, National Survey on Drug Use and Health and the National Survey on Family Growth. While the drug was approved by the Food and Drug Administration in 2012, a recent survey showed that a third of primary-care doctors had never heard of it.

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"We need to do more work to make sure clinicians are aware of PrEP," CDC deputy director director Anne Schuchat said in a phone call with reporters.

CDC guidelines suggest that the following groups of people may be at substantial risk of becoming infected and should consider PrEP:

  • Sexually active adults in an ongoing relationship with an HIV-infected partner
  • Gay and bisexual men who aren't in a monogamous relationship with a recently tested HIV-negative partner and don't always use condoms or have been recently diagnosed with a sexually transmitted infection
  • People who inject drugs that aren't prescribed by a clinician and don't always use sterile equipment
  • Heterosexual men and women who don't always use condoms with sexual partners who are at substantial risk for HIV infection

In San Francisco, where 15 percent of gay men are on PrEP, HIV infection rates have fallen dramatically. Last year, the city saw a record low of 302 new HIV diagnoses compared with more than 2,000 annually at the epidemic's peak. While CDC officials said it cannot credit PrEP alone for the low infection rates, they said the success shows it can work in combination with other prevention efforts.

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PrEP is estimated to cost about $10,000 a year, but Medicaid and most private insurances cover it.

"PrEP isn't right for everyone. No single method is, but it's right for some people, and when the men and women at high risk adhere to PrEP or whatever prevention methods work for them, we can make gains in national efforts," said Eugene McCray, director of the division of HIV/AIDS prevention at the CDC.

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This post has been updated.

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