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Pre-exposure prophylaxis could cut HIV incidence by 44%

Publish date: January 13, 2016
By
Amy Karon

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PrEP ready for prime time

Punyacharoensin and colleagues estimated that the greatest number of infections would be prevented in a practical combination prevention program that included pre-exposure prophylaxis alongside annual HIV testing for HIV-negative men and immediate treatment for HIV-positive men. In addition to promising findings from the PROUD study (Lancet. 2015 Sep 9. doi:10.1016/S0140-6736(15)00056-2), in which PrEP reduced the risk of HIV infection in MSM by 86%, the evidence is mounting for national policies in the UK and elsewhere that incorporate PrEP as a viable and accessible prevention strategy for MSM.

To maximize success, PrEP implementation needs to include the ability to engage with MSM communities and reach high-risk individuals, and should provide a point of access that is convenient and does not elicit fears of stigma, adherence counseling and monitoring for drug side-effects to ensure that individuals use PrEP effectively, and support for the uptake of complementary behavioral prevention strategies (e.g., reduced number of partners and condom use).

In addition, medical providers need guidance about how to manage patients receiving PrEP, and how drug and ancillary care costs should be covered. Finally, gay communities should be mobilized and educated about PrEP use and its use not only in prevention of HIV transmission but also in promotion of sexual health and well-being.

Dr. Emily A. Arnold and Dr. Wayne T. Steward are at the Center for AIDS Prevention Studies, University of California, San Francisco. They had no disclosures. These comments are based on their editorial (Lancet HIV. 2016 Jan 13. doi:10.1016/S2352-3018[15]00060-0).


 

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Rates of HIV infection in the United Kingdom could drop by 44% this decade if just a quarter of high-risk men who have sex with men receive pre-exposure prophylaxis, regular HIV testing, and early treatment, according to investigators.

“Our findings show that PrEP can be highly effective against HIV transmission at the population level, and could outperform other interventions at the same level of program coverage,” reported Dr. Narat Punyacharoensin of the London School of Hygiene and Tropical Medicine and his associates. The study was published online Jan. 13 in The Lancet HIV.

The incidence of HIV infection in the United Kingdom rose slightly in 2014, and shows no signs of reversing course. Among 104,000 UK residents living with HIV, about 43% are MSM, the researchers noted. After fitting a mathematical model with surveillance and behavioral data, they estimated the effects of seven HIV interventions targeting MSM, including expanded testing, test-and-treat programs, antiretroviral PrEP, and measures to reduce sexual partners and unprotected anal intercourse (Lancet HIV. 2016 Jan 13. doi:10.1016/S2352-3018[15]00056-9).

This image is a 3D illustration of the HIV virus. ©xrender/thinkstockphotos.com

This image is a 3D illustration of the HIV virus.

If nothing is done, the UK can expect about 17,000 new HIV infections by 2020, the model showed. But offering just 25% of high-risk MSM PrEP along with regular HIV testing and early treatment would prevent 7,399 HIV infections by 2020 (interquartile range, 5,587-9,813), or about 44% of the total incidence (IQR, 33-58).

“An increase in unsafe sex or sexual partners to 50% or more could substantially reduce the effect of interventions, but is unlikely to negate the prevention benefit completely,” the investigators added. “Pre-exposure prophylaxis could prevent a large number of new HIV infections if other key strategies, including HIV testing and treatment, are simultaneously expanded and improved. Without PrEP, HIV incidence in MSM in the UK is unlikely to decrease substantially by the end of this decade.”

The Health Protection Agency (now Public Health England), the Medical Research Council, and the Bill and Melinda Gates Foundation funded the work. The investigators had no disclosures.

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