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Truvada PrEP use rising in United States, especially among men
Liz Highleyman, 2014-11-07 10:10:00
The number of people
using Truvada for pre-exposure
prophylaxis (PrEP) in the US is increasing and a growing proportion of users
are men, according to an analysis of data from approximately half of American
pharmacies presented this week at the International Congress on Drug Therapy on HIV Infection in Glasgow.
PrEP refers to use of
antiretroviral medications to prevent HIV infection. Gilead Sciences' Truvada (tenofovir + emtricitabine)
taken once daily was shown to be effective in the iPrEx study of mostly gay and
bisexual men, reducing the risk of HIV infection by 42% overall, rising to 92%
among participants with blood drug levels indicating regular use. A
mathematical model suggested that taking Truvada four times per week would
provide 99% protection, and in an open-label extension of iPrEx none of
the men who took Truvada at least
this often became infected.
The US Food and
Drug Administration approved once-daily Truvada for PrEP in July 2012. In May
of this year the US Centers for Disease Control and Prevention recommended that
people at 'substantial risk' should consider PrEP to prevent HIV infection, and
the World Health Organisation has also recommended PrEP as an option for
at-risk gay men.
Yet uptake of Truvada PrEP has not been as widespread
as many had hoped, facing barriers such as lack of awareness among people at
risk for HIV, resistance from some medical providers and inconsistent insurance
In an effort to get
a better idea of the extent of PrEP usage in the US, Charlene Flash from Baylor
College of Medicine, Keith Rawlings from Gilead and colleagues analysed data
from a subset of pharmacies, looking at Truvada
prescriptions that were not written for HIV treatment (ie, for people who are
HIV-positive or also prescribed other antiretrovirals), for post-exposure
prophylaxis (PEP) or for off-label hepatitis B treatment (tenofovir alone is
approved for hepatitis B, but not Truvada).
Data were obtained
from 55% of pharmacies across the US from January 2012 through March 2014.
Importantly, this analysis did not include people accessing Truvada PrEP through Medicaid (medical
coverage for low-income people), clinical trials or demonstration projects.
Also, as the data
collection period ended in March of this year, it does not reflect an upsurge
in PrEP requests reported by some sources this summer, coinciding with
announcement of the iPrEx OLE data, stepped-up PrEP advocacy and extensive
Rawlings presented earlier PrEP usage figures at the 2013 Interscience Conference
on Antimicrobial Agents and Chemotherapy, reflecting prescriptions through
March 2013. Those data showed that Truvada
for PrEP was prescribed to 1,274 people in 2012 and 350 more during the first
quarter (Q1) of 2013. Nearly half of PrEP recipients were women, including a substantial
proportion in southern states. Some were probably HIV-negative women with HIV-positive
partners who were trying to conceive naturally.
The latest analysis
showed that 1,057 people were prescribed Truvada
for PrEP in the first three quarters of 2013, with a further 880 prescriptions
during the last quarter of 2013 and the first quarter of 2014. Overall, the
analysis counted 3,253 total unique PrEP users since January 2012.
Compared with the
earlier analysis, the proportion of women declined from 53.9% in the earliest
period (Q1-Q2 of 2012) to 26.7% in the latest period (Q4 of 2013 through Q1 of
2014). During the 12-month period of March 2013 through March 2014, the
proportion of new PrEP prescriptions among women fell from 44.5% to 22.9%.
The average age of PrEP
recipients remained approximately 38 years across all periods; however, the
proportion of PrEP users younger than 25 fell from 13.9% in early 2012 to 10.8%
during the latest period. Across all periods, women using PrEP were significantly
younger than men (36.4 vs 39.3 years, respectively) and more were under age 25
(7.4% vs 17.2%, respectively).
providers, over the entire period 68% of all Truvada PrEP prescriptions were written
by five specialties: internal medicine (19%), family practice (18%), infectious
diseases (11%), nurse practitioners (10%) and physician assistants (10%).
The population of Truvada PrEP
users in the US "appears to be shifting demographically", the
researchers concluded. "PrEP prescriptions continue to be initiated mostly
by non-infectious disease physicians".
In response to a question at the Glasgow meeting, Flash suggested that
the large proportion of women prescribed PrEP during the first two years may be
related to greater engagement of women in primary care, while the growth in
prescriptions to men who have sex with men during the latest period is likely to
be related to growing awareness of PrEP among this population.