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Increased PrEP Use = Fewer New HIV Infections, United States

A new analysis presented AIDS 2018 shows a correlation between higher PrEP use and lower HIV incidence in US states. An estimated 120,000 people had ever started Truvada for PrEP from its 2012 approval through early 2017, with just over 77,000 people taking PrEP in 2016 alone. But PrEP is still only reaching a small proportion of those who might benefit. The US Centers for Disease Control and Prevention (CDC) estimates that less than 10% of the 1.2 million people at substantial risk for HIV infection are using PrEP. In collaboration of researchers at Gilead and Emory University’s Rollins School of Public Health and CDC, the team presented a late-breaking poster that looked at correlations between PrEP use and HIV diagnosis rates, using data from people aged 13 and older in all 50 US states and Washington, DC, from 2012-2016. PrEP usage data came from pharmacies and diagnosis data from the National HIV Surveillance System. The states were divided into quintiles, or fifths, according to the proportion of people with a potential indication for PrEP who were receiving it. In the top quintile 11.0% of eligible individuals were on PrEP in 2016, compared with 3.5% in the lowest fifth. They noted that these figures represent a minimum level of PrEP use, as some people obtain PrEP from other than surveyed pharmacies.

Results: The overall HIV diagnosis rate decreased significantly from 2012-2016. During the same period PrEP use increased. There were some notable differences relative to PrEP use according to quintile. New HIV diagnoses declined (-4.7%) in the quintile of states with the highest PrEP use, and declined (-0.94%) in the medium-high group in an unadjusted analysis. In contrast, diagnoses increased in the quintile with the lowest PrEP use (+0.9%) and medium-low use (+1.53%). To assess the effect of PrEP vs. treatment as prevention, the researchers looked at viral load data from 37 states and DC. In this sub-analysis, the rate of PrEP use remained significantly associated with declines in new HIV diagnoses after controlling for state levels of viral suppression.

Conclusions: PrEP uptake was significantly associated with declines in HIV diagnoses in the US, and this association is independent of levels of viral suppression, the researchers concluded. They recommended that US states should take a two-pronged Status Neutral approach and (1) increase the use of PrEP among persons with indications, and (2) continue efforts to increase HIV viral suppression for people living with HIV. “By documenting significant declines in average new cases of HIV in states where Truvada for PrEP has been most widely adopted, our analysis emphasizes the importance of improving access to HIV screening and a full range of prevention tools, including PrEP, in US states,” Sullivan added.

Reference: Sullivan P et al. The impact of pre-exposure prophylaxis with TDF/FTC on HIV diagnoses, 2012-2016, United States. 22nd International AIDS Conference (AIDS 2018), Amsterdam, abstract LBPEC036, 2018.

Source: Reporting from Amsterdam for PRN News: Bill Valenti, MD

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