10 March 2016
By Natalie Healey
PrEP is not yet available on the NHS, but proponents say it could radically reduce new infections
After months of research, Greg Owen was excited to begin taking a daily pill which would protect him from HIV. But on the day he was due to start the course, he was told it was too late. He was already HIV positive.
The drug which Greg was supposed to start taking is called Truvada (which is also used with other medication for treating HIV). Truvada can be taken on its own to reduce the risk of contracting the infection, and doctors refer to this method as PrEP (which stands for Pre-exposure Prophylaxis).
There are now over 100,000 individuals living with HIV in the UK, and many people think PrEP could be a powerful tool to stop the spread of the virus. It’s not yet available through the NHS, but people can obtain the drug privately for a cost of around £400 a month.
Before he received his life-changing news, Greg had been informing readers of his blog about access to PrEP. He intended to diary his experience on the medication. But before he could start taking the pill, he needed to have an HIV test to ensure he was still negative.
“Twenty minutes after I arrive at the clinic I find out I’m HIV positive. So I had to put my money where my mouth is and tell the 6,500 people following my blog the truth…I didn’t know it would be a big thing, but it became a big thing. Because of my story, so many people were paying so much interest to what I was going through, because I’d just missed the boat, literally by a couple of months.”
So, along with his friend Alex, Greg started the website I Want PrEP Now to raise awareness of the medication. He, along with other advocacy groups, are campaigning for PrEP to be prescribed on the NHS as soon as possible.
“I thought if we could keep at least one person negative than my HIV status wouldn’t be for nothing,” he says.
Here’s your need-to-know on the pill that could prevent HIV:
1. It’s highly effective
In a large UK trial called the PROUD study where HIV negative men who have sex with men (MSM) were offered daily PrEP, the approach was found to be an effective way to prevent HIV infection (provided the men actually took the medication). The results showed that PrEP reduced the risk of infection for this group by 86%. Sheena McCormack, Professor of Clinical Epidemiology at the MRC Clinical Trials Unit at UCL, and Chief Investigator of the PROUD study, said:
“These results are extremely exciting and show PrEP is highly effective at preventing HIV infection in the real world. 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.”
It could have a great impact, as there were 6,151 new HIV diagnoses in 2014 in the UK. In London, one in eight gay men has HIV, while the proportion in the rest of the country is one in 26.
Dr Michael Brady, Medical Director at the Terrence Higgins Trust, a British charity that campaigns on issues related to Aids and HIV, says:
“PrEP has the potential to revolutionise our approach to HIV prevention. Perfect condom use is not a reality for everyone and, despite our efforts, the fact remains that the number of MSM infected with HIV in the UK every year has not really changed over the last decade.”
2. It’s already available in America
PrEP has been available in the USA since July 2012. Anyone who is HIV negative and considered to be in a high risk group (which includes all gay men and anyone who might have sex with a HIV positive person) can be prescribed PrEP by their doctor. And it’s covered by most health insurance plans. In New York, LA and San Francisco, PrEP is available for free for HIV negative people who earn less than $54,000 a year, whether they have health insurance or not.
“San Franciso has already reported a 30% reduction in new HIV infections over three years,” says Greg.
In France, PrEP was recently approved by the French government who will be reimbursing the cost to make it affordable for all.
3. Only people at risk of HIV need to take PrEP
Some argue that it’s counterintuitive to take HIV treatment in order to avoid taking HIV treatment in the future, but PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV. For instance, many people find their sexual behaviour changes over time (most often at the start or end of a relationship). It’s also thought PrEP may prove cheaper than the cost of treating HIV infections in the future. So the regime could allow people to take responsibility for their own sexual health rather than relying on another person to truthfully disclose their HIV status.
4. PrEP should only be used if you know you are HIV negative
If you take PrEP when you are HIV positive, there’s a risk your infection will become resistant to Truvada, and it won’t work to treat the virus effectively.
5. Most people taking PrEP don’t report side effects
That doesn’t mean taking PrEP isn’t a serious decision, because any medicine can have side effects. But Truvada has been used as part of HIV treatment for many years, and most people don’t report adverse effects from the drug. A minority experience stomach problems, headaches and tiredness during the first month but these often go away.
6. It probably won’t encourage risky behaviour
Critics of PrEP being made available on the NHS suggest that taking a daily pill to protect people from HIV would merely result in people adopting more risky behaviours or not bothering to use condoms. Some people are worried rates of other STIs will therefore increase.
But the PROUD study provided strong evidence that PrEP made no difference to such risk-taking. The levels of other STIs were almost the same in the group given PrEP and the group who did not have the drug. Condom use was also practically the same in both groups. Greg says:
“If people want this drug that’s not readily available, it’s because they know they’re at risk. My argument would be that instead of increasing rates of other STIs, what it’s actually doing is removing the main one off the menu. Give people the sort of protection they want and in the way they want it. And do you know what? People will bloody use it.”
If PrEP becomes more readily available, one condition for people taking it is they have to have an STI test every three months. So if the number of STI diagnoses did go up, it would mean health professionals could find and treat them more quickly.
7. The NHS is looking into whether it will prescribe PrEP
An NHS England process to evaluate PrEP is underway, but any decision to provide the drug will not be implemented until mid-to-late 2016 at the earliest. The health service will need to work out if the approach will be cost effective before it makes the medicine available.
Dr Brady believes that if prescribed to those who need it, most benefits of PrEP certainly outweigh the costs. The current lifetime cost to the NHS for a person living with HIV is around £360,000. He believes PrEP, when used in combination with HIV testing and treating those infection, could nearly halve the number of new infections over the next 5 years. Dr Brady says:
“PrEP is now available in a number of developed and developing countries and yet, despite the evidence of its effectiveness, a decision on whether or not it will be available on the NHS will not be made until at least June or July of this year. Every day approximately 7 MSM become infected with HIV and that will continue until we invest in HIV prevention strategies we know will work. We can’t afford to delay any longer!”