Blaylock Jason M, Hakre Shilpa, Decker Catherine F, Wilson Bryan, Bianchi Elizabeth, Michael Nelson, Beckett Charmagne, Okulicz Jason, Scott Paul T
Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889.
United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.
Mil Med. 2018 Mar 1;183(suppl_1):445-449. doi: 10.1093/milmed/usx143.
We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection.
Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described.
One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0-22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed.
In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.
我们评估了在服务于艾滋病病毒（HIV）感染高风险地理区域的沃尔特里德国家军事医疗中心（WRNMMC）进行的HIV暴露前预防（PrEP）给药情况。
回顾了2013年11月1日至2016年3月30日期间在WRNMMC开始接受PrEP治疗的所有患者的病历。描述了人口统计学、实验室、临床和风险暴露特征及结果。
159名患者接受了PrEP治疗；133名（84%）患者为现役军人，95名（60%）患者年龄超过28岁。大多数为非西班牙裔白人（n = 87，55%）。男男性行为者（MSM）风险指数评分中位数为18.0（四分位间距12.0 - 22.0）；20名患者评分低于10分。131名（82%）患者在评估期内持续接受PrEP治疗。患者主要因与服役相关或毒性原因停用PrEP。31名（19%）患者发生了新发性传播感染。未观察到HIV血清转化病例。
在对美国军事医疗系统中PrEP使用情况的首次描述中，相当数量的患者为非西班牙裔白人，受过良好教育，年龄较大，或以其他方式处于低HIV感染风险。需要进一步努力提高高风险年轻非裔美国MSM人群中PrEP的使用率，并且需要进一步研究以确定PrEP在未被归类为高风险个体中的成本效益。
