Expanded HIV testing, treatment, and PrEP use likely accelerated progress in reducing new HIV transmissions in the US over a 5-year period (2017-2021), according to the CDC1*
Estimated HIV incidence decreased 12% (2017 to 2021) and 20% (2012 to 2021)2-5*
*Estimates derived by using HIV surveillance and CD4 data for persons aged ≥ 13 years at diagnosis.
†Estimates for years 2020 and 2021 should be interpreted with caution due to adjustments made to the monthly distribution of reported diagnoses during those years to account for the impact of COVID-19 on HIV testing and diagnosis in the United States.4
In the real-world setting, substantial decreases in US HIV diagnosis rates have occurred among people who have been prescribed PrEP vs not prescribed PrEP6
In an analysis of longitudinal prescription and diagnosis data, the US HIV diagnosis rate was 61% lower among adults who were prescribed PrEP from October 2019 to June 2021 vs those not using PrEP in 20196
Real-world PrEP use in the US*†‡ was also significantly associated with a decrease in new HIV diagnoses over a period of five years7
*Among people ≥ 13 years of age indicated for PrEP from 2012-2016.
†In 33 jurisdictions (32 states and District of Columbia) for which there are complete laboratory reporting of HIV viral suppression data for ≥ 3 years from 2013 through 2015.
‡Data shown for quintiles below do not represent estimated annual percent change (EAPC) for individual states.
A large, real-world study examined PrEP use among ~14,000 adults in the US who received PrEP care during a 6-year period8*†
*The 2021 retrospective cohort analysis used electronic health records data from a Northern California integrated health system; prescriptions were filled for PrEP medications for adults (≥18 years of age) with an indication for PrEP.
† N=13,906.
Among individuals engaged with PrEP care at any point during the retrospective study period (July 2012 to March 2019):
- 52.2% of those initiating PrEP discontinued at least once during the study period8
- 60.2% of those who discontinued reinitiated PrEP before the end of follow-up8
The study also revealed HIV incidence rate estimates were highest among individuals who were prescribed PrEP and did not initiate, as well as those who discontinued and did not reinitiate PrEP8
| PrEP status | # of HIV infections / Total # of individuals | Total follow-up, person-years | Incidence (95% CI), per 100 person-years |
|---|---|---|---|
| Overalla | 91/13,861 | 26,210 | 0.35 (0.28-0.43) |
| Linked but not prescribed PrEP | 36/3,013 | 4,119 | 0.87 (0.63-1.21) |
| Prescribed PrEP but did not initiate | 13/811 | 1,226 | 1.06 (0.62-1.83) |
| Discontinued but reinitiated PrEP | 4/1,082 | 1,420 | 0.28 (0.11-0.75) |
| Discontinued and did not reinitiate PrEP | 38/2,108 | 2,973 | 1.28 (0.93-1.76) |
| Persistent on PrEPb | 0/5,367 | 9,139 | 0.00 (0.00-0.04)c |
aExcludes individuals who were diagnosed with HIV during the eligibility assessment at PrEP linkage.
bPersistent on PrEP refers to individuals who initiated and remained on PrEP throughout follow-up.
cOne-sided 97.5% upper CI.
For some individuals, PrEP discontinuation may reflect a decrease in HIV risk and is a deliberate decision.
However, HIV incidence among those who discontinued PrEP and did not reinitiate and the higher rates of discontinuation in key subgroups disproportionately affected by HIV suggest broader systemic barriers.8
According to the CDC, efforts must be further strengthened and expanded to reach all populations equitably1
Maintaining open access for all PrEP options is important
to minimize barriers that may stand in the way of PrEP use
and to accommodate diverse individual needs and risk profiles
- Centers for Disease Control and Prevention. Expanding PrEP coverage in the United States to achieve EHE goals. Published October 17, 2023. Accessed January 2, 2024. https://www.cdc.gov/nchhstp/dear_colleague/2023/dcl-101723-prep-coverage.html
- Centers for Disease Control and Prevention. Estimated annual HIV infections in the U.S., 2010-2016; new HIV infections nationally, 2010-2016. Published 2019. Accessed January 2, 2024. https://www.cdc.gov/nchhstp/newsroom/docs/2019/HIV-Incidence-Data-Tables_508.pdf
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019.HIV Surveillance Supplemental Report 2021 ;26(No. 1). Published May 2021. Accessed January 2, 2024. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2017–2021: Tables. Published May 31, 2023. Accessed January 2, 2024. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/content/tables.html
- Centers for Disease Control and Prevention. HIV in the U.S. by the Numbers – 2021. Published September 29, 2023. Accessed January 2, 2024. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/hiv-in-the-us-by-the-numbers.html
- Tao, L. et al. Real-world geographic variations of HIV diagnosis rates among individuals prescribed and not prescribed oral HIV pre-exposure prophylaxis regimens in the United States. Poster presented at IDWeek conference; October 19-23, 2022; Washington, D.C. Poster 1482.
- Smith DK, Sullivan PS, Cadwell B, Waller L, Siddiqi A, Mera-Giler R, Hu X, Hoover KW, Harris NS, McCallister S. Evidence of an association of increases in pre-exposure prophylaxis coverage with decreases in human immunodeficiency virus diagnosis rates in the United States, 2012-2016. Clin Infect Dis. 2020;71(12): 3144–3151. doi.org/10.1093/cid/ciz1229.
- Hojilla JC, Hurley LB, Marcus JL, et al. Characterization of HIV preexposure prophylaxis use behaviors and HIV incidence among US Adults in an integrated health care system. JAMA Network Open. 2021;4(8):e2122692. doi:10.1001/jamanetworkopen.2021.22692.