Pre-exposure treatment to help prevent HIV Wider use of Pre-Exposure Prophylaxis (PrEP), where people who don’t have HIV take a pill every day, could prevent around 7,400 new HIV infections in the UK by 2020. David Rowlands examines the evidence and calls for the NHS to follow France in offering the treatment for most-at-risk populations. The PrEP pill contains the two medicines tenofovir and emtricitabine, which are also used to treat HIV. For those who are exposed to HIV through sex or injection drug use, PrEP can work to keep the virus from taking hold. Along with other prevention methods, like condoms, PrEP can offer good protection against HIV if taken daily. Offering PrEP alongside regular HIV testing and early treatment to just a quarter of men who have sex with men (MSM) at high risk of contracting the virus could prevent almost half the number of new diagnoses in that period, boosting calls for the method to be provided free on England’s NHS. New modelling research published in The Lancet HIV journal suggests that, between 2014 and 2020, almost 17,000 new HIV infections in MSM will emerge. Researchers estimated that, even when targeted only at high-risk men, PrEP was more effective than all other individual measures aimed at the entire UK MSM population. Most recent Public Health England figures show an estimated 103,700 people in the UK were living with HIV in 2014,
with around 18,100 unaware and at risk of unknowingly passing the virus on to others. Among the MSM group, 6,500 remained unaware of their HIV infection. High levels of transmission in MSM continue, with 3,360 MSM newly diagnosed in 2014 – the largest number ever recorded.
Can anyone use PrEP?
PrEP may be considered for people who are HIV-negative and at substantial risk for HIV infection. This includes anyone who: • Is in an ongoing relationship with an HIV-infected partner; • Is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative and is a gay or bisexual man who has had sex without a condom or been diagnosed with a sexually-transmitted infection within the past six months; • A heterosexual man or woman who does not regularly use condoms when having sex with partners known to be at risk for HIV (e.g. injecting drug users or bisexual male partners of unknown HIV status); or
David Rowlands
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Has, within the past six months, injected illicit drugs and shared equipment, or been in a treatment programme for injection drug use; For heterosexual couples where one partner has HIV, PrEP is one of several options to protect the uninfected partner during conception and pregnancy.