Flash Charlene, Landovitz Raphael, Giler Robertino Mera, Ng Leslie, Magnuson David, Wooley Staci Bush, Rawlings Keith
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA, USA.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19730. doi: 10.7448/IAS.17.4.19730. eCollection 2014.
Truvada® (TVD) was approved in July 2012 by the US FDA for pre-exposure prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 in high-risk adults. This study explores the characteristics of US PrEP users and their prescribers over the past two years.
A previously described algorithm was used to identify TVD for PrEP by excluding use for HIV treatment, post-exposure prophylaxis, and off-label treatment of chronic hepatitis B. National electronic patient level data from ~55% of all US retail pharmacies that dispensed TVD between January 1, 2012 and March 31, 2014 was collected. De-identified patient-level data including prescription refill data, medical claims and patient demographics were analyzed via logistic regression to estimate the odds of change by year.
A total of 3253 unique individuals who started TVD for PrEP between January 1, 2012 and March 31, 2014 were included in this analysis. Women comprised 42.0% of PrEP users. Although mean age was 38.1+11.9 years, with males being significantly older (39.3+11.6) than females (36.4+12.3), 11.5% of individuals were under 25 years old. The proportion of males under 25 was 7.4% (95% CI 6.3-8.7); significantly lower than that of women, 17.2% (95% CI 15.3-19.3). New starts have increased from 293 in 2012 to 472 Q1 2014. During the 12-month period ending March 31, 2013 and March 31, 2014 the number of new starts among females dropped from 44.5% to 22.9%.
The population of TVD for PrEP users in the US nationally appears to be shifting demographically. It continues to be initiated mostly by primary care providers. Over a two-year period new starts of Truvada for PrEP have increased considerably among males. While the overall proportion of female users decreased between Q1 2012 and Q1 2014, females that started on PrEP are younger than males. More community-level data on PrEP usage will be helpful in informing local efforts to integrate PrEP in HIV prevention messaging and services.
2012年7月，美国食品药品监督管理局（FDA）批准特鲁瓦达（Truvada®，TVD）用于暴露前预防（PrEP），并结合安全性行为，以降低高危成年人通过性接触感染HIV-1的风险。本研究探讨了过去两年美国PrEP使用者及其开处方者的特征。
采用一种先前描述的算法，通过排除用于HIV治疗、暴露后预防和慢性乙型肝炎的非标签治疗，来识别用于PrEP的TVD。收集了2012年1月1日至2014年3月31日期间约55%的美国零售药店分发TVD的全国电子患者层面数据。通过逻辑回归分析去识别的患者层面数据，包括处方 refill数据、医疗理赔和患者人口统计学信息，以估计逐年变化的几率。
本分析纳入了2012年1月1日至2014年3月31日期间开始使用TVD进行PrEP的3253名独特个体。女性占PrEP使用者的42.0%。尽管平均年龄为38.1±11.9岁，男性（39.3±11.6岁）明显比女性（36.4±12.3岁）年龄大，但11.5%的个体年龄在25岁以下。25岁以下男性的比例为7.4%（95%置信区间6.3 - 8.7）；显著低于女性的17.2%（95%置信区间15.3 - 19.3）。新开始使用的人数从2012年的293人增加到2014年第一季度的472人。在截至2013年3月31日和2014年3月31日的12个月期间，女性中新开始使用的人数比例从44.5%降至22.9%。
美国全国范围内用于PrEP的TVD使用者群体在人口统计学上似乎正在发生变化。它仍然主要由初级保健提供者发起。在两年时间里，男性中用于PrEP的特鲁瓦达新开始使用人数大幅增加。虽然2012年第一季度至2014年第一季度女性使用者的总体比例有所下降，但开始使用PrEP的女性比男性年轻。更多关于PrEP使用情况的社区层面数据将有助于为当地将PrEP纳入HIV预防信息和服务的努力提供参考。
