Two European studies of pre-exposure prophylaxis (PrEP), PROUD1 and IPERGAY2, reported early results in October 2014. Both studies showed that PrEP was so effective at preventing HIV transmission that everyone in these studies has now been offered PrEP. The comparison arms, which respectively offered delayed PrEP or a placebo, have been closed.
In light of this news, together with data on continued high rates of new infections3, the NHS urgently needs to make PrEP available.
Although an NHS England process to evaluate PrEP is underway, any decision to provide PrEP will probably not be implemented until early 2017, which is too long to wait. We are calling for earlier access to PrEP. The NHS must speed up its evaluation process and make PrEP available as soon as possible. Furthermore, we call for interim arrangements to be agreed now for provision of PrEP to those at the highest risk of acquiring HIV.
What is PrEP?
PrEP stands for Pre-Exposure Prophylaxis. It involves a person who doesn’t have HIV taking pills regularly to reduce their risk of HIV infection. Several studies show that PrEP works.
PrEP is currently only available in the UK to people enrolled in the PROUD study,4 but has been available in the US since 2012.
Why do we need PrEP?
There are now over 100,000 people living with HIV in the UK. 5 We need to improve HIV prevention.
Tens of thousands of HIV transmissions have been prevented by condom use.6 However many people do not use condoms all of the time and each year there are thousands of new infections. PrEP has the potential to prevent new infections among some of those at greatest risk of acquiring HIV.
Condom use will remain a core strategy in HIV prevention. PrEP gives people who already find it difficult to consistently use condoms an additional way to protect their health.
Due to the high rate of HIV infections, there is a particular need for the NHS to make PrEP available to gay men. However it should be available to all people who are at high risk of acquiring HIV.
How effective is PrEP?
Research suggests that PrEP is as effective as condoms in preventing HIV transmission, as long as the pills are taken regularly, as directed. Evidence from a large international study suggests that gay men who maintained at least four doses a week had 96% fewer infections.7 8 Preliminary results from separate studies of PrEP in the UK9 and France10 both show that PrEP substantially reduces infections among gay men. Full results are expected early in 2015. PrEP has also proven effective for heterosexual couples in which one partner is HIV positive and not on HIV treatment.11
PrEP does not prevent other sexually transmitted infections or pregnancy. It allows someone to protect their own health, irrespective of whether their partner uses a condom. Because it is taken several hours before sex, it does not rely on decision-making at the time of sex.
Why take HIV treatment to avoid taking HIV treatment?
People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV. Many people find that their sexual behaviour changes over time, for example when they begin or end a relationship.
Does PrEP have side-effects?
Any medicine can have side-effects, so taking PrEP is a serious decision. The drugs in PrEP have been used as part of HIV treatment for many years. This has shown that they have a low risk of serious side-effects. Most people taking PrEP don’t report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away. People taking PrEP have regular check-ups at a clinic.
Does PrEP mean people take more risks?
The full results of the PROUD study will help us understand the impact of PrEP on condom use among gay men in the UK. But other studies of PrEP have consistently reported that being on PrEP did not result in people adopting riskier behaviours. 12 13 14 Instead it gives people who already find it difficult to consistently use condoms a way to protect their health.
- Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. November 2014.
- For more information, http://www.proud.mrc.ac.uk
- Public Health England. HIV in the United Kingdom: 2014 London: Public Health England. November 2014.
- Phillips AN et al. Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic. PLoS ONE 8(2): e55312. doi:10.1371/journal.pone.0055312.
- Grant RM et al. Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. New England Journal of Medicine 363:2587-2599, 2010.
- Anderson PL et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine 4: 151ra125, 2012.
- Baeten JM et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine 367: 399-410, 2012.
- Marcus JL et al. No Evidence of Sexual Risk Compensation in the iPrEx Trial of Daily Oral HIV Preexposure PLoS ONE 8: e81997, 2013.
- Mugwanya KK et al. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infectious Diseases 13: 1021–28, 2013. 14 Grant RM et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infectious Diseases 14: 820-829, 2014.
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