HIV pre-exposure prophylaxis could help 1.2 million in USBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6384 (Published 25 November 2015) Cite this as: BMJ 2015;351:h6384
More than 1.2 million people in the United States are at high enough risk for HIV infection to be candidates for daily oral pre-exposure prophylaxis (PrEP) but most are not receiving the treatment, officials at the US Centers for Disease Control and Prevention (CDC) said on 24 November.
Currently, the CDC recommends the combination of two antiretroviral drugs, tenofovir disoproxil fumarate and emtricitabine, taken in a single pill daily to prevent HIV in people at high risk for the infection. This combination, marketed in the US as Truvada, was approved for PrEP by the US Food and Drug Administration in 2012. However, only about a third of primary care physicians and nurses in the US are aware of PrEP for HIV prevention, CDC officials said.
“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said Tom Frieden, CDC director. “With about 40 000 HIV infections newly diagnosed each year in the US, we need to use all available prevention strategies.”
In randomized controlled trials PrEP reduced new HIV infections by 92% in men who had sex with men (MSM), by 90% in heterosexually active couples in which one partner was infected with the virus and the other was not, and by 73.5% in injecting drug users. Follow-up open label studies have found that community based PrEP delivery achieved adherence and outcomes as good as or better than those seen in the randomized controlled trials.
The new study appeared in the 24 November issue of the CDC’s Morbidity and Mortality Weekly Report.1 The lead author, Dawn K Smith, of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), and colleagues analyzed national, population based surveys to estimate the percentages and numbers of adults in the US for whom PrEP is indicated on the basis of the US Public Health Service’s 2014 PrEP guidelines.2 They focused on three groups at high transmission risk: MSM, injecting drug users, and sexually active heterosexual adults.
The researchers found risks for acquiring HIV indicating that PrEP would be beneficial in approximately:
One in four (24.7%) sexually active adult MSM (492 000 (95% confidence interval 212 000 to 772 000)),
One in five (18.5%) injecting drug users (115 000 (45 000 to 185 000)), and
One in 200 (0.4%) heterosexually active adults (624 000 (404 000 to 846 000)).
Overall, an estimated 1 232 000 adults (661 000 to 1 803 000) had a high enough risk of HIV infection for PrEP to be indicated, the researchers concluded.
Jonathan Mermin, NCHHSTP director, said the findings showed that PrEP had the potential to reduce new HIV infections dramatically in the US. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed,” he added.
Cite this as: BMJ 2015;351:h6384