More than one in nine people worldwide who might benefit from a daily pill to minimize their risk of getting HIV are now taking this medicine, a research review suggests.
HIV pre-exposure prophylaxis (PrEP) with a pill containing emtricitabine and tenofovir disoproxil fumarate is recommended for people at high risk for infection with HIV, including men who have sex with men, people who inject illegal drugs, and some people who have unprotected sex.
For the current analysis, published August 8 online in the journal AIDS, researchers examined data from 72 studies published from 2006 to 2018. Most were done in the U.S. and involved men who have sex with men.
In the U.S., nearly one in six study participants and nearly one in four men who have sex with men who were eligible for the pill, called Truvada, were using it by 2016, the study found.
âSelf-reported PrEP use among these men is approximately doubling each year,â said lead study author Emiko Kamitani of the U.S. Centers for Disease Control and Prevention in Atlanta.
âIf current efforts to promote effective PrEP use are maintained, we may see maximum coverage of PrEP use within several years,â Kamitani said by email. âHowever, this will require addressing substantial gaps that we know, from this research, exist among other populations.â
Thatâs because while dramatic gains in PrEP use have been seen among men who have sex with men, the same isnât true among people who inject illegal drugs and heterosexual people who have sex with partners at high risk for developing HIV, Kamitani said.
In the U.S. alone, an estimated 1.2 million people should be on PrEP, the study authors note. Only about 120,000 people have filled prescriptions at retail pharmacies between 2012 and early 2017, which suggests many who need treatment arenât getting it.
Truvada can also treat HIV, and itâs unclear how many people got prescriptions for treatment versus for prevention. This count also excludes prescriptions filled in other settings.
Another limitation of the analysis is that some of the studies relied on participants to report on their own use of PrEP.
âIn addition, the estimate reported doesnât distinguish between those who had ever used PrEP and those currently using PrEP,â said Matthew Beymer, a researcher at the University of California, Los Angeles, David Geffen School of Medicine and at the Los Angeles LGBT Center.
Many people who start PrEP donât continue with treatment, Beymer, who wasnât involved in the study, said by email. Some people who would benefit from PrEP may not never start taking it at all because they donât consider themselves at high risk for HIV, Beymer added.
âThere are multiple barriers to PrEP uptake among people who might benefit from PrEP, including not being aware of PrEP, inaccurate assessment of HIV risk, and the high cost of the medication and follow-up visits,â said Julia Marcus, a researcher at Harvard Medical School in Boston and Harvard Pilgrim Health Care Institute who wasnât involved in the study.
âWe also know there are barriers to PrEP prescribing for some providers, including lack of familiarity with PrEP, difficulty identifying patients at risk of HIV acquisition, and concerns about potential unintended consequences of PrEP use,â Marcus said by email. âWe need to work toward mitigating each of these barriers if the population-level benefits of PrEP are to be realized.â
By Lisa Rapaport