Only 1 in 5 US HIV Doctors Surveyed Uses PrEP, Despite High Awareness

Only 1 in 5 US HIV physicians surveyed in 2011 used antiretrovirals for preexposure prophylaxis (PrEP), even though large majorities knew about early PrEP research and Centers for Disease Control and Prevention (CDC) guidance. PrEP has proved effective in men who have sex with men (MSM), heterosexual men and women, and injection drug users in four placebo-controlled trials. To gauge awareness and uptake of PrEP among US HIV physicians, researchers conducted an online survey of 189 members of the American Academy of HIV Medicine between April 2011 and September 2011. Thus the survey took place after publication of the iPrEx results in MSM and during release of the Partners PrEP and TDF2 trials in heterosexual men and women.

Among the 189 respondents, 90% knew about iPrEx results and 78% were familiar with CDC interim guidance on PrEP for MSM, which followed the iPrEx findings. But only 19% of respondents had prescribed PrEP.

Most PrEP prescribers complied with CDC guidance. But only 61% of prescribers screened PrEP candidates for hepatitis B virus (HBV) infection, which is essential because the drugs now used for PrEP, tenofovir and emtricitabine, both have anti-HBV activity. Starting and stopping these drugs can result in hepatitis flares.

Among PrEP prescribers, 78% prescribed PrEP for MSM, but 31% prescribed it for heterosexual men and 28% for women. One third of survey respondents expressed concern about development of resistance as a result of PrEP, 22% worried about a potential increase in high-risk behavior, and 21% had concerns about adherence to PrEP, which must be taken daily or almost daily in its current form.

Among PrEP prescribers, 58% said HIV discordance in a couple most influenced their decision to prescribe PrEP for the HIV-negative partner.

The authors note that their study is limited by a low response rate, changes in the PrEP evidence base, and the novelty of PrEP.

Source: David Tellalian, Khalid Maznavi, U. Fritz Bredeek, W. David Hardy. Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices. AIDS Patient Care and STDs. 2013; 27: 553-559.

Written by Mark Mascolini on behalf of the International AIDS Society