You don’t have to get HIV before you deal with
it — a daily pill can dramatically cut a person’s
risk of contracting the virus.
The pre-exposure prophylaxis (PrEP) has been
trialled in the UK, yielding results described as
“extremely exciting” and a “game-changer” by
leading specialists.
The Proud study found that PrEP cut the risk of
HIV infection among gay men considered to be
at high risk by an unprecedented 86 per cent.
Despite major advances in the fight against
HIV/Aids in recent decades, the infection rate
among men who have sex with men remains
stubbornly high in the UK.
The study was funded by UK government
agencies, the Medical Research Council and
Public Health England.
PrEP has been available to at-risk groups in the
United States since 2012.
The Proud trial, which took place across 12
NHS trusts in Brighton, London, York,
Manchester, Birmingham and Sheffield, was set
up to provide real-world evidence on the pill’s
effectiveness, and to answer outstanding
questions, such as whether providing it would
lead to reduced use of condoms.
Some 545 HIV-negative gay men, who were
sexually active and had recently had
unprotected sex, were recruited to the study.
Early findings proved so encouraging that in
October last year the trial was sped up to
ensure 269 men whose access was going to be
deferred were given the drug straight away.
Among the 276 men given PrEP immediately,
there were only three HIV infections in the first
year of the study, compared with 19 among the
deferred group.
The pill used in the trial, Truvada, is a
combination of two antiretroviral drugs which
has previously been used to treat HIV infection.
Developed by Gilead, its newly established
ability to prevent as well as treat the virus
marks a major turning point in efforts to
combat HIV among high-risk groups.
“These results are extremely exciting and show
PrEP is highly effective at preventing HIV
infection in the real world,” said Sheena
McCormack, professor of clinical epidemiology
at the MRC Clinical Trials Unit at University
College London.
“Concerns that PrEP would not work so well in
the real world were unfounded. These results
show there is a need for PrEP, and offer hope
of reversing the epidemic among men who
have sex with men in this country. The findings
we’ve presented today are going to be
invaluable in informing discussions about
making PrEP available through the NHS.”
Men taking part in the study reported they did
not change their condom use because of PrEP
– evidence that was borne out by the fact that
infection rates of other STIs were similar in
both groups.
An estimated 2,800 gay men acquired HIV in
the UK in 2013 and the rate of new infections
has remained high for a decade.
Six per cent of gay and bisexual men are now
living with HIV, rising to 13 per cent in London.
“During the study period there were 19 HIV
infections in the group not taking PrEP,” said
Deborah Gold, chief executive of the National
Aids Trust.
“If we can stop people getting HIV by giving
them PrEP, we have an ethical duty to do so.
Furthermore, over the course of their lifetime
the treatment of those 19 men will cost the NHS
nearly £7m. So the financial argument is clear,
as is the ethical one. PrEP needs to be available
on the NHS as soon as possible for all those
who need it.”
Professor Simon Barton, chair of the HIV
Clinical Reference Group for NHS England,
which will review the cost-effectiveness of
PrEP, said the Proud trial findings were “very
important”.
“The challenge now is to translate the benefits
demonstrated in the study into practice,” he
said.
“We have already begun work to carefully
consider how this treatment could be delivered
equitably and most efficiently by liaising closely
with the Local Government Association, Public
Health England, clinicians and patient
representatives.”
Dr Michael Brady, medical director of sexual
health charity the Terrence Higgins Trust, said:
“PrEP is, quite simply, a game-changer. We
know that most gay men use condoms most of
the time, and that this has prevented tens of
thousands of HIV infections since the epidemic
began in the UK. However, we also know that
condomless sex vastly increases the risk of HIV
being transmitted.
“This research shows just how effective PrEP
can be in preventing transmission of the virus
in groups at greatest risk; offering another line
of defence alongside condoms and regular
testing. It is not a vaccine and it won’t be for
everyone, but once approved, we expect it to
significantly increase the momentum in our
fight against the virus. Therefore, we urge the
Government, NHS England and local authorities
to make PrEP a key priority in the fight against
HIV.”



www.thecable.ng/now-drug-prevent-hiv-infection

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