The French IPERGAY study shows the effectiveness of PrEP on demand in high-risk patients who have infrequent intercourse.
The Congress of the International AIDS Society took place from July 23 to 26 at the Palais des Congrès in Paris. It was the opportunity to present the latest advances in terms of treatment, and the possible future of prevention.
New results from the ANRS IPERGAY study, presented by Dr Guillemette Antoni, confirm the benefit of PrEP, but this time in men who have sex with men (MSM) infrequently (5 reports per month).
97% efficiency
One of the most significant advances in recent years is PrEP (Pre-Exposure Prophylaxis). Sometimes criticized because suspected by some of promoting risky practices, it remains today a pillar of the preventive arsenal available to physicians.
This preventive anti-retroviral treatment against HIV infection, intended for populations at risk, consists of taking Truvada® by mouth. Its purpose is to prevent HIV from infecting cells in the body by blocking its replication and penetration into cells.
Its effectiveness in studies ranges from 86 to 99%. The French IPERGAY study has just shown, in results published on July 24, 2017, an efficiency of 97% for taking on demand.
Taking the treatment on demand in this randomized trial allows 100% efficacy (6 contaminations in the placebo group versus 0).
“Revolution”
“There is a real awareness that there is a revolution in prevention and that the means must be put into it”, rejoiced Professor Jean-Michel Molina, during the presentation of these results. He underlined that “PrEP is a very effective method of prevention” coming in addition to the condom.
Only broad information to populations at risk will make it possible to integrate this tool into the existing arsenal in order to reduce the evolution of the epidemic. Professor Molina also recalled that this new option associated with the regular medical monitoring that it imposes does not increase the risk of STIs. On the contrary, PrEP could reduce it, as has already been observed in Great Britain.
PrEP in practice
Truvada® can be prescribed by a specialist doctor as part of a Marketing Authorization for its indication in PrEP since March 2017. A renewal by the general practitioner is then possible.
Two prescription schemes exist :
- Continuously, one tablet of Truvada® every 24 hours;
- On demand, 1 taken between 24 hours and 2 hours before sexual intercourse then every 24 hours as long as the sexual activity continues. If sexual activity stops, one tablet should be taken 24 hours, then 48 hours, after taking before intercourse. If no tablet has been taken in the last 7 days, then the first dose should consist of two to improve preventive effectiveness.
The effectiveness of this treatment is obtained after 7 days of continuous intake for MSM, and 21 days for women. This is because the medicine takes longer to penetrate the vaginal tissues.
For taking on demand, this preventive efficacy is obtained when 2 tablets are taken at the latest two hours before sexual intercourse.
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