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Experts recommend giving HIV drugs to healthy gay men

Offering PrEP to at-risk gay men could prevent 44% of new infections

Adrian O'Dowd

Thursday, 14 January 2016

Giving healthy gay men antiretroviral therapy (ART) taken as pre-exposure prophylaxis (PrEP) could help reduce new HIV infection rates by more than 40% in the UK, claims a study* published online today in The Lancet HIV journal.

Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy in which people at high risk of becoming exposed to HIV take antiretroviral drugs to reduce their chance of becoming infected.

Recent years have seen around 6,000 people test positive for HIV each year - more than half are gay and bisexual men. Around 44,980 gay and bisexual men and around 54,000 heterosexuals were estimated to be living with HIV in the UK by the end of 2014.

Dr Narat Punyacharoensin, who conducted the research while at the London School of Hygiene & Tropical Medicine, and colleagues, used a model to evaluate the ability of various HIV prevention measures (such as expansion of HIV testing, test-and-treat programmes, PrEP, and sexual behavioural changes) to avert HIV infections in men who have sex with men aged 15 to 64 in the UK between 2014 and 2020.

If the status quo was maintained, the researchers predicted 16,955 new HIV infections in men who have sex with men between 2014 and 2020.

The 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 men who have sex with men population, preventing 59% of new infections (9,955).

The research shows that offering PrEP alongside regular HIV testing and early treatment to just a quarter of men who have sex with men at high risk of contracting HIV could prevent around 7,400 new HIV infections (44% of total incidence) in the UK before 2020.

However, they predicted that the greatest number of infections would be prevented by a “practical combined prevention programme” that included PrEP alongside yearly HIV testing for HIV-negative men and immediate ART for HIV-positive men.

Given the concern that PrEP might make men feel they can increase their sexual risk-taking because they are protected by prophylaxis, the researchers calculated that even a substantial increase in unprotected anal intercourse and sexual partners was unlikely to completely counteract the strong HIV prevention benefit of prophylaxis.

Dr Punyacharoensin said: “Current prevention efforts in the UK that focus on correct and consistent condom use and regular HIV testing have been falling short.

“HIV rates among men who have sex with men remain high with around 2,800 men who have sex with men becoming infected with HIV in 2014, and the trend shows no sign of abating.

“Our results show that pre-exposure prophylaxis offers a major opportunity to curb new infections and could help reverse the HIV epidemic among men who have sex with men in the UK.”

Charity the Terrence Higgins Trust’s medical director Dr Michael Brady said: “Pre-exposure prophylaxis has been shown, both in clinical trials and in ‘real life’ settings, to be highly effective at preventing HIV transmissions.

“This study is really important as it demonstrates that, in a relatively short space of time, PrEP could have a dramatic impact on reducing HIV transmissions. It also shows the importance of a combination approach to HIV prevention i.e. utilising PrEP alongside other interventions such as increasing HIV testing rates and earlier treatment for those who are infected.”

*  Punyacharoensin N, et al. Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: a mathematical modelling study. The Lancet HIV, 2015. DOI: 10.1016/S2352-3018(15)00056-9

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