The Mayor of Greater Manchester has said that HIV-preventing drugs should be made available on the NHS. It comes on the heels of a CDC report that shows approximately 1.2 million people should be taking PrEP. This includes 25 per cent of sexually active gay and bisexual adult men, almost 20 percent of adults who inject drugs, and less than 1 per cent of heterosexually active adults. The research, which will be published tomorrow in the New England Journal of Medicine, was led by Dr. Jean-Michel Molina of Hôpital Saint-Louis in Paris and Dr. Jean-François Delfraissy of France’s ANRS Research Agency. “It’s very high – very exciting data”. Two were in the medication group and 14 in the placebo group.
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“This is an incredibly exciting development in terms of the HIV prevention landscape”, Parkhill said. But she also notes that stopping HIV transmission won’t be possible just by writing Truvada prescriptions. However, taking the drug daily proved to be a challenge for some.
Participants were told to take two pills before sex, a third pill 24 hours after having sex, and a fourth pill 24 hours after that. “The hard part is getting it to the patients who need it most and getting those patients to adhere to their medication regimens”, he said. Most trial participants used condoms some of the time, only forgoing them when it seemed safe, after asking their partners when they were last tested and when they’d had unsafe sex (see “Why I don’t always use condoms”, below). And according to the latest city statistics, 793 – or 58.7% of new cases in the city – were among men who have sex with men.
Truvada costs about $900 a month without insurance. Reduced prevention funding for CBOs in the South, groups best positioned to reach communities at risk for HIV, will only serve to increase the HIV burden in this region.
Awareness about PrEP has really taken off by word of mouth, Gallant says. “When we do that in combination with others who are leading research, we will eventually end HIV”.
Prophylaxis refers to preventing or controlling the spread of an infection or disease. Combined with access to health care, regular testing and other HIV prevention strategies such as condoms, PrEP provides people with a game-changing way to stop HIV. Yet Truvada users are making highly nuanced decisions about their risks, argues Sheena McCormack of University College London, who helped run a trial of daily Truvada.
“There are many barriers to accessing pre-exposure prophylaxis right now, Truvada“, Tooley said.
While majority of the doctors said that PrEP will reduce HIV infections and they would recommend it to patients, some doctors said there are both pros and cons to the therapy. “Cost is absolutely still an issue”. No HIV negative men on a PrEP trial anywhere has contracted HIV, despite many participants being in serodiscordant (with an HIV+ partner) relationships. (Tremblay said it’s different in Quebec because coverage is extended to off-label drugs.) And front-line practitioners may be reluctant to prescribe Truvada off-label.
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“While it may not be possible to say precisely how long it will take to review Gilead’s submission, the Department’s target review time for this type of submission, where a new indication is being sought, is 300 days”, Health Canada spokeswoman Rebecca Gilman said in an email.
