November 30, 2016
|Top 10 Clinical Developments of 2016|
|1. Donald Trump||6. Return of the Antibodies|
|2. Switch Frenzy||7. Is an Unexpected Low HIV RNA Level Real?|
|3. 2-Drug ART||8. Dolutegravir and the Central Nervous System|
|4. Is HIV PrEP at a Tipping Point?||9. TAF in Hepatitis B|
|5. Start ART Now||10. New HIV infections in U.S. Are Down -- a Bit|
Tenofovir/emtricitabine (TDF/FTC, Truvada) was approved for use as pre-exposure prophylaxis (PrEP) to prevent HIV infection way back in 2012 -- the year Mitt Romney challenged President Obama's re-election. Although that may seem like a billion years ago, it wasn't, and since then, the uptake of PrEP has been steadily increasing. As reported at the 2016 International AIDS Conference by the Centers for Disease Control and Prevention (CDC), about 80,000 people were prescribed PrEP from 2012-2015. However, the CDC estimates there are 1.2 million people in the U.S. whose risk for HIV makes them candidates for PrEP (including 490,000 men who have sex with men (MSM), 115,000 people who inject drugs and 624,000 heterosexual men and women). Moreover, 76% of these PrEP users were men. Other data suggest that only a fraction of those prescribed PrEP is not white or male.
Given disparities in access to medical care and HIV-prevention messaging, it may not be a surprising that white men were most likely to adopt PrEP. While PrEP uptake in this population is a good thing, those who can most benefit from PrEP are not receiving it. Recent modeling performed by the CDC estimates the lifetime risk of HIV infection to be 1 in 20 for African-American men and 1 in 48 for African-American women and Hispanic men. Bad, but it gets worse. MSM had an astounding 1 in 6 risk and this jumped to a mind boggling 1 in 2 for African-American MSM.
PrEP is an effective and important tool in our shallow HIV prevention toolbox. Real-world studies have shown that it works. However, a number of studies show that there is incredibly limited awareness of the existence of PrEP among people who are candidates for it and among health care providers.
It should take nothing more than the risk faced by MSM, particularly MSM of color, to justify a massive push to get PrEP to all who can benefit from it, regardless of who they are, where they live or how much they make. Certainly, PrEP in its current incarnation is not perfect. For now, it is still a pill that needs to be taken most every day. The TDF component can drop bone density a few percentage points, and PrEP does not protect against other major sexually transmitted infections (STI). Recent data show that, among adolescent MSM, adherence to PrEP is pitiful. However, it still saves lives and money.
What do we need to do stop PrEP from being a best-kept secret from those who are at risk and the primary care providers who care for them? As a provider who has become evangelical about PrEP, I believe what is needed to make it as accessible as oral contraceptives is exposure and action:
During the past year, an undercurrent of progress has been made. Stakeholders have started to mobilize to spread the word about PrEP. The first PrEP-related advertising has launched. My prediction is that PrEP will take off and the steep climb in uptake will be one of the top stories of 2017. Let's all help to make it so.
What are some other top clinical developments of 2016? Read more of Dr. Wohl's picks.
David Alain Wohl, M.D., is a professor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill, director of the North Carolina AIDS Training and Education Center and site leader of the University of North Carolina Chapel Hill AIDS Clinical Research Site.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
No comments have been made.
The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.