NZAF Responds To PrEP Trial
NZAF Responds To PrEP Trial
The New Zealand AIDS Foundation (NZAF) notes results from the first-ever human study of a treatment called pre-exposure prophylaxis (PrEP) that has shown it to be effective in reducing sexual transmission of HIV. The clinical trials, published in the 25 November issue of the New England Journal of Medicine, gave 2,499 HIV negative gay and bisexual men a combination of two antiretroviral (ARV) drugs. The results showed that HIV infections were 44% lower in the group taking PrEP than the control group which took a placebo. Antiretroviral drugs are used to treat people living with HIV and have been credited with dramatically reducing the mortality rate from AIDS in developed countries but this is the first trial to use ARVs as a preventive measure.
Rachael Le Mesurier, New Zealand AIDS Foundation Executive Director says: “We are very hopeful that this study will lead to further research into making PrEP more effective. There is the potential for PrEP to play a role in HIV prevention.”
Despite the promising results there are numerous challenges ahead. The ARVs used in the study are available in their component parts in New Zealand but not in a single pill and the cost is significant. Le Mesurier says: “This drug would cost more than $10,000 per person, per year, in New Zealand and at 44% effective, it’s still no match for condoms and lube which have an efficacy rate of more than 90%. Everyone involved in HIV prevention and healthcare here, and around the world will be considering PrEP carefully and how it fits with other HIV prevention interventions.”
Access to ARVs remains extremely difficult around the world. UNAIDS has estimated that only 36% of people living with HIV who need ARVs could access them just one year ago which means that the roll-out of PrEP for HIV negative people is highly unlikely in countries where access to ARVs is already seriously limited.
In addition to these issues, adherence poses another challenge to PrEP. Study participants learned about PrEP and the importance of adherence as part of the trial but researchers reported that only about half of study participants took the medication consistently. Compounding the problem of adherence is the challenge of developing communication strategies about an intervention that is just 44% effective - and only when taken in combination with a full complement of prevention services.
Le Mesurier says “This study opens the door to new possibilities. However, with World AIDS Day coming up next week, it’s a very timely reminder that we are still in the midst of an epidemic in New Zealand and that we still don’t have a silver bullet to stop HIV. Condoms and lube are still the best way to prevent HIV. ”