US survey of the prescribing of Truvada (tenofovir/emtricitabine)
to HIV-negative people as pre-exposure prophylaxis (PrEP) has found that, when
participants in clinical trials and demonstration projects are excluded, PrEP
recipients are more likely to live in the southern states and are more likely
to be female than people receiving Truvada for HIV treatment.
found that prescriptions for PrEP represented perhaps 1% of all Truvada
prescriptions, though use has grown slowly. However, the majority of PrEP in the
US is still being prescribed in the context of clinical trials: this survey
represents prescribing outside trials, by individual doctors in a variety of healthcare
In addition, the survey only acquired prescription information
from 55% of all US pharmacies, so the true figure for PrEP prescriptions will be somewhat higher.
US Food and Drug Administration (FDA) approved the use of Truvada as PrEP in July 2012. Although, so far at least, its use has only
grown slowly, it began to gather speed even before the FDA approval. The survey found prescriptions for PrEP
made out to 150 individuals in 2011.
2012, Truvada PrEP was prescribed to 1274 individuals, but only slightly more
than half of these (681) were prescribed after the FDA approval. In the first
quarter of 2013, 350 more individuals were prescribed PrEP, implying a total of
at least 2000 for the whole year. However, with Truvada
being one of the most frequently prescribed antiretroviral drugs for HIV
treatment, this probably only represents 1-2%, at most, of Truvada prescribing
in the US.
total of 620 healthcare professionals (37% of all those surveyed) were found
to have prescribed PrEP at least once during the survey period, from January
2011 to March 2013.
median age of PrEP recipients was 37 and there was a trend over time for PrEP
recipients to be younger (3% of recipients were under 25 in 2011 compared with
was most likely to be prescribed by family practitioners (i.e. GPs) in the
southern states, and primary care prescribing was also more common on the west
coast. In areas other than the south, PrEP was most likely to be prescribed by
internal medicine practitioners (i.e. generalist physicians rather than the infectious disease specialists who would normally treat HIV) and in the midwest
it was often prescribed by emergency doctors too. However, all broad medical
specialities prescribed some PrEP, including nurse practitioners, who prescribed
about one in 10 courses.
figures were derived by looking at all prescriptions for Truvada from the pharmacies surveyed and sequentially
prescriptions that included other antiretrovirals or hepatitis B drugs.
patients diagnosed with HIV or where these was any diagnosis of an AIDS-related
patients with chronic hepatitis B.
prescriptions for post-exposure prophylaxis (PEP).
remainder were all deemed to be PrEP prescriptions.
compared to people receiving Truvada
for HIV treatment, PrEP recipients were 1.8 times more likely to be women, 1.4
times more likely to be under 24 years old, 1.4 times more likely to be from
the southern states and 3.8 times more likely to have Truvada prescribed by someone who was not an infectious diseases
It is important to emphasise that a high proportion of PrEP in the US is currently
being prescribed in the context of a clinical trial or demonstration project.
In California alone, the state HIV/AIDS research programme plans to enrol 4000
people in PrEP implementation trials. These may be more likely to be gay men
attending larger sexual health centres.