Pre-exposure prophylaxis (PrEP) for HIV: effective but controversial

Despite continuing public information campaigns, there were 6095 new diagnoses of HIV in the UK in 2015. 75% of these new infections occurred in men, and men who have sex with men (MSM) were disproportionately affected, accounting for 56% of new infections.

Pre-exposure prophylaxis, or PrEP as it is widely known, provides hope that many of these new infections could be prevented. PrEP usually consists of a combination of tenofovir with emtricitabine (Truvada).

The UK PROUD study in HIV-negative men who had sex with men and who had had anal intercourse without a condom in the past 90 days showed that HIV incidence was reduced by 86% for those on PrEP compared to those in the deferral treatment group. This means that to prevent one new HIV infection, you would have to treat 13 men of a similar population with PrEP for one year. This is likely to be highly cost-effective.

Potential issues are that people on PrEP will engage in riskier behaviour and there is some concern that drug resistance could increase.

There is an ongoing issue around whether the NHS will pay for PrEP. At the moment, most people taking PrEP are obtaining it privately – many in an uncontrolled fashion via the internet.

What do you think? Should PrEP be available to selected groups on the NHS? What concerns would you have? Is it really any different to the introduction of the contraceptive pill in the 1960s? Comment below.

Read Max Kelen and Fiona Cresswell’s accompanying article here

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