HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center

• Published in: Military medicine 2018-03, Vol.183 (suppl_1), p.445-449
• Main Authors: Blaylock, Jason M, Hakre, Shilpa, Decker, Catherine F, Wilson, Bryan, Bianchi, Elizabeth, Michael, Nelson, Beckett, Charmagne, Okulicz, Jason, Scott, Paul T
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Armed forces; Demographics; Disease control; Disease prevention; Epidemiology; Female; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV-1 - drug effects; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Male; Medical laboratories; Medical records; Middle Aged; Military medicine; Military Medicine - methods; Military Medicine - trends; Military personnel; Military Personnel - statistics & numerical data; Pre-Exposure Prophylaxis - methods; Pre-Exposure Prophylaxis - standards; Risk exposure; Risk Factors; Tertiary Care Centers - organization & administration; Tertiary Care Centers - statistics & numerical data
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usx143

Abstract Objectives We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection. Methods Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described. Results One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0–22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed. Conclusions In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.