Background: In 2012 Truvada (TVD) was licensed for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 for adults at high risk in the USA.
We describe the TVD for PrEP utilization in the US, including user and prescriber characteristics
Methods: We used nationally representative (82% of retail pharmacies) de-identified data (Symphony Health Analytics) on individuals who received a TVD prescription from Jan 2013 to Dec 2015. The data warehouse contains medical claims, diagnosis codes, and patient and provider demographics. A validated algorithm was used to quantify TVD for PrEP use by excluding TVD for HIV treatment, HIV post-exposure prophylaxis and chronic Hepatitis B treatment. Logistic regression analyses were used to compare demographic data from TVD use for HIV treatment or PrEP.
Results: Between January 2013 and December 2015, 49,469 unique individuals started TVD for PrEP: 3,746 in 2013; 14,756 in 2014; 30,967 in 2015. 87.5% were male. Mean age was 37.4 years, with 11.5% under age 25. Fig 1 shows regional distribution of TVD PrEP starts over time. There were 19,274 prescribers across 50 states. Four states (CA, NY, TX, FL) with the highest HIV incidence account for 43.0% of PrEP starts. Compared to HIV positive patients, uninfected individuals receiving TVD for PrEP were 3.1 times less likely to be female (95% CI 3.0 - 3.2), but 1.98 times more likely to be under age 25 (95% CI 1.93 - 2.05).

Fig 1: Distribution by region over time
[Fig 1: Distribution by region over time]

Conclusions: The number of individuals starting on TVD for PrEP has increased nationally since the 2012 approval in the US, and is primarily male. States with the highest number of new HIV cases also had the highest number of TVD PrEP starts. Despite positive trends in TVD for PrEP use, utilization must increase to ensure lifetime risk seroconversion decreases in areas of high prevalence HIV in the US.