Update from Dr Steve Wignall

16 November 2015

The evidence grows stronger… we need to be thinking about PrEP

Steve WignallAt the recent Conference on Retroviruses and Opportunistic Infections in Seattle, USA researchers added to the continuing body of evidence that ‘pre-exposure prophylaxis’ or PrEP can prevent most new HIV infections among those with high risk behaviors. The combination pill including tenofovir and emtricitabine, two commonly used antiretroviral drugs has been shown effective and well tolerated.

A French and Canadian PrEP study, IPERGAY, found that the HIV infection rate in participants taking an intermittent PrEP regime of two pills before anticipated sex and one after if it occurred – was 86% lower than in people taking an inactive placebo. Intermittent dosing lowered costs by 50% compared to other daily dosing PreP while maintaining similar levels of effectiveness.

Another English PrEP study, PROUD, demonstrated a similar level of effectiveness was 86%; for every 20 infections that might have occurred in participants, 17 were stopped by PrEP. Three HIV infections occurred among 276 participants randomised to immediately start taking daily tenofovir/emtricitabine, and 19 in 269 participants asked to wait a year before starting PrEP.

These studies were able to be done quickly and with a comparatively small group of individuals because of the high incidence of HIV infections in the study populations. The HIV infection rates in these English and French gay men are similar to those among gay men in Indonesia where there is a population of gay men at imminent risk of HIV that could be cost-effectively protectec by PrEP.

Bali Peduli hopes to be working with an international donor later this year to begin a PrEP study among our clinic patrons.