PrEP: a flawed prevention strategy for HIV/AIDS
by Peter Saunders, MercatorNet:
The High Court of the United Kingdom recently that the National Health Service in England can fund a drug that can reduce the chance of people catching HIV whilst engaging in high-risk sexual activities.
NHS England had previously argued that local municipal councils should provide PrEP (“pre-exposure prophylaxis”) as “health prevention” is their responsibility.
But Mr Justice Green said that NHS England had “erred” and that both it and the local authorities were able to fund the drugs. Summing up, he said:
“No one doubts that preventative medicine makes powerful sense. But one governmental body says it has no power to provide the service and the local authorities say that they have no money. The clamant [the National Aids Trust] is caught between the two and the potential victims of this disagreement are those who will contract HIV/Aids but who would not were the preventative policy to be fully implemented.”
The ruling has understandably evoked praise from gay rights campaigners and AIDS charities but consternation from NHS England which intends to appeal the decision. It is concerned about the effectiveness of the strategy, the precedent it creates for funding other “disease prevention” measures and the way resources might be drawn from other health priorities were it to get the go-ahead.
The once a day pill known as PrEP, trade-named Truvada, consists of two antiretroviral medications used for the treatment of HIV/AIDS (tenofovir and emtricitabine or TDF-FTC) and costs £400 a month per person. The total cost to the health service could be in the order of £10 to 20 million.
It is currently used in the United States, Canada, Australia and France to help protect the most at-risk gay men.
According to the CDC (Centers for Disease Control) in the US, PrEP is for people who do not have HIV but who are at substantial risk of getting it. It should be used in combination with other “HIV prevention” methods, such as condoms, but even in these circumstances is not foolproof.
The CDC reports studies have shown PrEP reduces the risk of getting HIV from sex by more than 90 percent when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70 percent when used consistently.
But these figures are what is achievable with good adherence (consistent use), and many of those most at risk are very likely not to adhere with taking the pills regularly.
An authoritative Cochrane review is far less reassuring. Overall, results from four trials (Baeten 2012; Van Damme 2012; Grant 2010; Thigpen 2012) that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection by about 51 percent.
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