U.S.
Advocates Offer Strategies for Pre-exposure Prophylaxis to Prevent
HIV Infection
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| SUMMARY:
The National PrEP Committee, a new coalition of
treatment advocates, policy experts, and others,
has released a report on strategies for using pre-exposure
prophylaxis, or taking antiretroviral drugs as a
way to prevent HIV infection. Recently published
data from the iPrEx
trial showed that daily use of tenofovir/emtricitabine
(Truvada) reduced the risk of HIV acquisition
by 44% among gay and bisexual men, but many questions
remain regarding adherence, cost, and other potential
concerns. |
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By
Liz Highleyman
PrEP
is not a novel idea, and medications are routinely used to
prevent other infectious diseases such as malaria, according
to the National PrEP Committee, which includes Project Inform,
the AIDS Vaccine Advocacy Coalition (AVAC), Community HIV/AIDS
Mobilization Project (CHAMP), and the National Alliance of
State and Territorial AIDS Directors (NASTAD).
However,
the report cautions, "PrEP would require longer courses
of therapy in many cases, and its administration, which includes
ongoing medical observation to monitor for side effects, HIV
testing and behavioral counseling, would be much more rigorous."
"Here
we offer specific ideas regarding individuals who may be candidates
for PrEP, possible sources for its delivery, its financing,
and other important considerations for advocates and policymakers,"
the report continues. "We realize that many questions
regarding the use of PrEP will remain unanswered for some
time."
Overall,
the Committee takes a favorable stance toward PrEP, while
discussing unresolved issues related to safety, drug resistance,
adherence, effectiveness, implementation, and financing.
"Even
if private insurance covers the cost of PrEP, many insured
individuals may be afraid to receive it through their own
physicians and insurance companies out of fear of judgment
about their behaviors," they wrote. "As is frequently
the case with HIV testing, some privately insured individuals
may be more likely to use PrEP if it is made available through
community-based, publicly funded sources. Building and financing
a new program of this kind may be difficult in the current
economic and political climate, and given concerns about a
growing ADAP waiting list. But advocacy to build a distinct
funding stream to pay for PrEP for those individuals who are
not included in health care reform or who will not rely on
their private insurance may be necessary, wise and cost-effective."
The
Committee concludes with several recommendations, including
advising governments and AIDS service organizations to prepare
to advise HIV negative people interested in starting PrEP
right away, asking public and private insurers to cover the
cost of PrEP drugs for high-risk individuals, and requesting
that Gilead Sciences seek FDA approval for prophylactic use
of Truvada.
"People
who successfully use PrEP could be spared HIV infection and
a life-time of antiretroviral drug treatment, frequent laboratory
work, co-morbidities, adjustments to drug regimens, the stigma
of HIV infection and an unnecessarily shortened lifespan,"
the report concludes. "Furthermore, the same individuals
who are at high risk of acquiring HIV infection may also be
at high risk of transmitting HIV should they become HIV-positive
and not engaging in effective treatment. Using PrEP to prevent
the exponential transmission to multiple individuals and their
sex partners may be one way to move toward a remarkable decrease
in annual HIV incidence."
The
complete National PrEP Committee report is available online
at www.projectinform.org/prep/Strategies.pdf.
12/14/10
Reference
National
PrEP Committee. Strategies
for Using Pre-Exposure Prophylaxis (PrEP) to Lower HIV Incidence
in Select Populations Policy Considerations and Suggestions
of the National PrEP Committee. December 1, 2010.
