Amsterdam 2015
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| Abstract #3429 - Plenary | ||||
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Session: 4.5: Plenary (Plenary) on Wednesday @ 09.00-11.00 in C103 Chaired by Kai Jonas, Lucie Cluver, Catherine Hankins Authors: Presenting Author: Prof Sheena McCormack - MRC Clinical Trials Unit , United Kingdom |
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| Additional Authors: | ||||
| Aim: Europe was well aware of the ongoing epidemic in gay and other men who have sex with men (MSM) when iPrEX reported a 44% reduction in HIV incidence in MSM and transgender women (Grant et al, NEJM, 2010). In fact, the data gathered over the preceding decade suggested that new infections might be increasing in MSM, in spite of widespread access to treatment and good control of viral load in those on antiretroviral therapy. However, we were cautious about launching PrEP programmes (McCormack et al, Int J STI&AIDS 2012). There were a number of concerns, not least of all the cost of drug and that MSM taking PrEP would abandon other risk reduction strategies which would increase their risk of being exposed to HIV and potentially undermine effectiveness. Although sub-group analysis in iPrEX and other PrEP trials suggested that biological efficacy could be very high, the population benefit was modest as a large proportion of trial participants did not take the trial drug. Two European trials were launched in 2012 (iPerGay and PROUD) and the results provide two clear messages: HIV incidence was higher than expected in MSM who came forward to access PrEP, and they were willing to take Truvada to reduce their risk of HIV so the population benefit was substantial (86% reduction in HIV incidence in both trials). The effectiveness of PrEP exceeded the expectation of the researchers, and was the largest benefit reported in intent to treat analyses (CROI 2015). iPerGay demonstrated that Truvada was highly effective when MSM were advised to take PrEP before and after sex. The control group was given placebo as it was necessary to control for behaviour in this design. In contrast, PROUD was an open-label study comparing PrEP to no-PrEP in order to assess the effectiveness when MSM knew they were taking a drug that reduced their risk of HIV ie taking account of any behaviour change. Those on PrEP continued to report condom use amongst their risk reduction strategies, and there was no difference in other sexually transmitted infections between the groups. There is no doubt of the potential that PrEP has to reverse the epidemic. To realise the full benefit, PrEP will need to be provided during periods of risk, and be embedded in a comprehensive risk reduction package that includes support for behaviour change. This will require effective partnerships between community organisations working with at risk populations, clinicians providing sexual health and HIV services, epidemiologists and public health policy makers. PROUD and iPerGay have sparked interest, but in many European countries the partnerships necessary to deliver PrEP will be new, and demonstration projects will help to build these successfully, ensuring that we do reverse the current epidemic trend. | ||||
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