Crédit Jason Lewishamdreamer (Flickr).

PrEP: A new tool in combating HIV

TRANSLATED BY ALISON ARLOW AND THOMAS SHACKLOCK

For decades, science has attempted to develop a treatment to fight against HIV. What if instead of this, we were to do upstream research into how to prevent contamination? Such is the principle of pre-exposure prophylaxis, known as PrEP. Some reports from the London debate have seen it called a “miracle” solution by some and as controversial by others, sparking interest in the medical field.

HIV (Human Immunodeficiency Virus) was still the sixth highest cause of mortality in the world in 2012, according to the World Health Organisation. The virus is caused by AIDS (Acquired Immune Deficiency Syndrome) when the immune system becomes over exhausted and is no longer able to protect itself. This “pestilence” of the 80’s tended to be simplified and is now being brought to the forefront once again.

Infographics

In 2014, there were, according to UNAIDS, 36.9 million people living with HIV. That same year, around 2 million new infections were counted while the number of deaths resulting from AIDS rose to 1.2 million.

The number of people living with the virus is ironically enough, relatively good considering the fact that new infections have decreased. This in turn shows that more people living with the virus are living more positively and for a longer time. Today it is no longer a death sentence but a mere diagnosis for many HIV positive people.

The global response against this disease has created a decline in the number of new infections to 35% since 2000 and 58% in children. The number of deaths has decreased 42% since it reached its peak in 2004. Evidently, the situation is not the same everywhere. In Sub-Saharan Africa, the Caribbean, Latin America and the Asia-Pacific, rates of infection have consequently dipped. Whereas in the Middle-East, North Africa, Eastern Europe and even Central Asia they have increased. Numbers remain stable in western and central Europe and in North America. Similarly, the number of deaths follow this trend in different regions, recording a decline of 12% in western and central Europe and in North America. However it has almost tripled in the Middle-East and North Africa!

Anti-retroviral; Current treatment against HIV

The differences between regions can be used to explain the different ways it can be transmitted. It can arise from the taking of intravenous drugs, the sex trade or simply the lack of understanding of means of transmission. In the case of the Middle-East and North Africa, the rise in the number of new infections is primarily due to the lack of access to HIV treatment and antiretroviral therapy (ARV). On the other hand, the global decline in HIV is greatly due to a better accessibility to treatment on average. Thanks to which, HIV positive people are able to rebuild an effective immune system that allows them to fight against diseases. It does not cure patients but prevents the virus from multiplying which can damage organs. Equally, this allows us to reduce the presence of the virus to a minute number that we qualify is as undetectable thus preventing new infections from emerging during sexual intercourse. In this respect, we often talk about “Treatment as Prevention”, in other words treating an infection in order to reduce the likelihood of onward transmission.

However, even if the progress made in terms of treatment is vast, it is still not enough. The objective of this lasting development is to find a means to put an end to this epidemic by 2030. Yet, as the W.H.O explained in 2016 “On a global scale, the progress regarding the prevention of HIV is at a dead-end.” It may well be however that an efficient method of remedying the problem has just been discovered.

PrEP; A new tool in the fight against HIV?

The prevention and treatment of HIV represents, according to UNAIDS, a 17- fold return on investment. It’s necessary to say that it is costly to treat a HIV positive person. The treatment alone costs is steep: €700 a month in France. It should not be forgotten that on top of this that there are regular check-ups and in the long term, potential extra costs for poor health. According to Slate, the cost for society to follow-up a HIV positive person amounts to €980,000 (in Canada). That is why, it is better to invest in the most effective prevention possible.

PrEP is a medicine taken directly from antiretroviral which are used to treat HIV. It generally acts on Truvada®, that is formed from a combination of two of the three molecules used in ARV. Many studies have shown its efficiency. On average there would be an 86% reduction in the risk of infection if the treatment is taken correctly. However the medicine is only available to a few countries and is not refunded in France since January 2016. A box of 30 tablets costs around €500, which poses a serious obstacle to many populations. What’s more, medical consultations and related biological analysis are not fully refunded by social welfare. Some complementary health insurers cover the rest, otherwise it’s your responsibility. In this respect, the Coalition PLUS published a statement arguing that PrEP be accessible throughout Europe.

A striking example

Among the 36.9 million people living with HIV in the world, 17.1 million overlook the symptoms. It is precisely the latter that risks the transmission of the virus. This is particularly true in the most developed countries as access to treatment is less problematic. There is therefore a need for upstream preventive action. To find a new way of preventing the transmission of the virus so that we don’t allow the epidemic to get away from us once again.

PrEP might be extremely effective, as proven by this example.

https://www.buzzfeed.com/patrickstrudwick/meet-the-man-who-stopped-thousands-of-people-becoming-hiv-po?utm_term=.xpQOrA6YdX#.oxm6Dqrol2.

It may well make it possible to lower the rate by a third in England with a site providing accessible medicine. His story adheres to this idea, the larger battle for access to medicine, a problem which concerns the European Union. But this question merits its own article…

Banner photo: an action organised by Act Up London, 2 July 2015. Under the posters: “Make PrEP accessible to the NHS. NOW.” “PrEP has been available in the USA since 2012. Why not the UK?” Credit to Jason Lewishamdreamer (Flickr).

 

 

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