For three years, the National AIDS Research Agency will monitor the impact of prevention in the capital on 3,000 volunteers.
We are in Paris, in 2030. AIDS has disappeared. In the French capital, no more cases of HIV are declared. What is still fiction may well become reality. Because the city of light wants to put an end to new contaminations. The objective is ambitious, but assumed. And the Île-de-France region has followed suit with the capital.
Titanic work will be required to achieve this. Every day, 7 Ile-de-France residents discover their HIV status. To support the program “Towards Paris without AIDS », The National Agency for Research on AIDS and Hepatitis (ANRS) is therefore committed. In order to monitor the evolution of the epidemic, it has launched several projects. Among them, PREVENIR, which assesses the impact of pre-exposure prophylaxis (PrEP).
Horizon 2020
Taking antiretrovirals to prevent contamination may be the backbone of the fight against the virus. This strategy, which complements the usual preventive approaches, is likely to slow down the epidemic considerably. In any case, this is what the Ipergay trial suggested, which allowed the official authorization of Truvada for HIV prevention.
PrEP reduces the risk of HIV infection by 86%. Taken correctly, it offers even greater protection. But what about in real life? This will be shown by the PREVENIR program, which has already recruited 150 people since its launch in May 2017.
A total of 3,000 people are expected to join the trial for a period of three years. “Its objective is to document the evolution of diversified prevention among men who have sex with men (MSM) in the city of Paris, the obstacles that we encounter”, summarizes Professor François Dabis, director of the ‘ANRS. And why not, in the best case scenario, show that this broader approach improves the effectiveness of campaigns.
A global approach
Participants in PREVENIR will therefore have two choices: use PrEP in a continuous schedule – with one tablet per day – or according to the schedule tested and approved in France – two tablets before risky intercourse, another 24 hours after and a last 48. hours later.
But the trial won’t just focus on PrEP. It will also assess the impact of “diversified prevention”. This includes, of course, Truvada for prevention, but also all of the other prevention methods – condom use, frequent screening, systematic treatment, etc.
“HIV is just one sexually transmitted disease among others,” recalls Professor Dabis. MSM are very affected by various STIs. This is why a global offer of sexual health is necessary.
Prof. François Dabis, director of the ANRS: ” PrEP will not be opposed to all prevention offers. Both joint screening and consistent management must be offered. “
Forgotten populations
Unlike the Ipergay trial, which is more limited, PREVENIR aims to target all people at risk of HIV transmission. “MSM are the core target”, concedes François Dabis. But they won’t alone.
Sex workers and transgender people will also have the option of joining the follow-up group. “Transgender people are little studied but we know that they are very affected by STIs,” underlines the director of the ANRS. Prevention, including the use of PrEP, is very low. There is a real stake here. “
The stakes are even higher now that the vast majority of PrEP recipients are men who have sex with men. Other high-risk populations, such as migrants from sub-Saharan Africa or transgender people, do not go to hospitals that offer these consultations. This failure will have to be overcome by the coordinating team of “Towards Paris without AIDS”.
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