PrEP for Women

Truvada for pre-exposure prophylaxis (PrEP) to prevent HIV transmission has been available to at-risk patients since it was approved by the FDA in 2012.  Despite this, it has found limited use among non-MSM (men who have sex with men) for HIV prevention. Truvada (emtricitabine/tenofovir disoproxil) is a pill that can be taken once a day that, when used consistently, can reduce the risk of acquiring HIV by more than 90%¹.  Truvada is generally well tolerated and is covered by most private insurance and Medicaid.  The CDC currently recommends PrEP for women with a known HIV+ sexual partner, a recent bacterial STI, multiple sexual partners, inconsistent or no condom use, women living in high prevalence areas, or women who are commercial sex workers¹.  The only criteria for starting PrEP are a negative HIV test and no signs/symptoms of acute HIV, normal renal function, and a documented hepatitis B status. 

 

Despite these generally broad recommendations for PrEP, few women are currently using it.  The use of PrEP has seen massive growth in the MSM community; however, the uptake of PrEP among women has been slow.  In data released by Gilead, the pharmaceutical company that produces Truvada, only 2,491 women were using PrEP in 2015 (approximately 20% of all patients using PrEP), which remained relatively stable from 2012 through 2015².  Yet, the CDC estimated in 2015 that 0.6% of women aged 18-59, or 468,000 women, had indications for using PrEP³.  Additionally, of those women initiating PrEP, significantly fewer African American women have used PrEP as compared with White women, despite being at greater risk of acquiring HIV².  According to data from the CDC, African American women are the group of women most at risk of acquiring HIV⁴.  4,189 African American women were estimated to be newly diagnosed with HIV in 2016 as compared with 1,032 White women and 1,025 Hispanic women⁴.  This absence of PrEP use is likely due to patients and physicians underestimating patients' HIV risk as well as a lack of knowledge regarding the use of PrEP in heterosexual females.  Those aware of PrEP often think of it as something that is purely for the MSM population and do not think of women that live in communities with high HIV prevalence.  Discussing the initiation of appropriate heterosexual females on PrEP is something that should be prioritized by primary care physicians as a means of further preventing HIV transmission, particularly in communities with high HIV prevalence. 

1. Centers for Disease Control and Prevention. Pre-exposure prophylaxis (PrEP) for HIV prevention. 2014. Available at: https://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf (accessed Dec 2017)
2. Bush, S. Magnuson D, Rawlings MK, et al. Racial characteristics of FTC/TDF for pre-exposure prophylaxis (PrEP) users in the US.  ASM Microbe 2016, 16-20 June 2016, Boston, MA.  
3. Smith DK, Van Handel M, Wolitski RJ et al. Vital signs issue details: estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV Acquisition – United States, 2015. MMWR Morb Mortal Wkly Rep. 2015; 64: 1291–1295.
4. Centers for Disease Control and Prevention. Basic Statistics.  Available at: https://www.cdc.gov/hiv/basics/statistics.html (accessed Dec 2017).

Alyssa Mezochow

DUCOM 2018