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PrEP Prevents HIV in Real-World Setting

No new cases of HIV infections among population using Truvada

A study published in Clinical Infectious Diseases this month described the effects of pre-exposure prophylaxis (PrEP) on human immunodeficiency virus (HIV) in a real-world setting. Referrals for and initiation of PrEP for HIV infection have increased dramatically in a large clinical practice setting since 2012. Despite high rates of sexually transmitted infections among PrEP users and reported decreases in condom use in a subset, there were no new HIV infections in this population.

The effectiveness of once-daily oral PrEP using emtricitabine/ tenofovir disoproxil fumarate (Truvada, Gilead Sciences) for prevention of sexually acquired HIV infection has been demonstrated in trials and open-label studies; however, data on PrEP use outside of the research context are limited. Interest in PrEP was high among men who have sex with men (MSM) in a demonstration project in the U.S., yet initial pharmacy data indicated that many at-risk individuals were not accessing PrEP. In addition, despite reassuring data suggesting that sexual risk behavior and the incidence of sexually transmitted infections (STIs) did not increase in PrEP trials, few data on sexual behavior or STIs have been reported among PrEP users outside of research settings.

This study aimed to characterize patterns of PrEP use among members of the Kaiser Permanente Medical Center in San Francisco. The study described characteristics of individuals evaluated for and initiating PrEP, trends in PrEP referrals and initiation, incidence of HIV and other STIs among PrEP users, and self-reported changes in condom use and number of sexual partners after PrEP initiation.

The researchers observed a dramatic increase in PrEP use in a clinical practice setting, with no new HIV infections among PrEP users. This was despite high rates of STIs — rectal STIs in particular — and self-reported decreases in condom use in 41% of a subset of PrEP users. Interest in and use of PrEP was almost exclusively among MSM, reflecting the HIV epidemic in San Francisco and a rapid increase in awareness and acceptance of PrEP use in this community.

Source: Clinical Infectious Diseases; September 2015

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