The effectiveness of antiretrovirals in preventing HIV infection is this time confirmed and published. PrEP on demand reduces the risk of transmission by 86%.
Trial transformed for pre-exposure prophylaxis (PrEP)! The National AIDS Research Agency (ANRS) publishes the results of the Ipergay clinical trial in the prestigious New England Journal of Medicine. This work is evaluating the value of taking the antiretroviral Truvada (Gilead) as a preventive measure in men at high risk of HIV infection. Taking “on demand”, tested in France and Canada, provides the highest level of protection ever observed.
400 men who have sex with men (MSM) took part in the research. Half took Truvada, the other half took placebo, according to an “on demand” schedule. Before unsafe sex, the volunteers took two tablets. They repeated the intake 24 hours and 48 hours after intercourse. During follow-up, with a median duration of 9.3 months, 16 cases of infections were recorded. This corresponds to a relative risk reduction of 86%.
No more risk taking
“We have reached a level of protection that has never been so high, with a much less restrictive intake and fewer side effects than continuous PrEP”, welcomes Professor Jean-Michel Molina, signatory of this work. contacted by Why actor. In fact, Truvada for prevention is already authorized in the United States, but the MA (marketing authorization) only covers a daily tablet.
PrEP “on demand” therefore has the advantage of being lightened, which improves patient compliance. Drug detection is greater than 80% in participants. “It is both linked to the intake pattern, but also to the support offered by the doctors and associations with whom we have worked,” underlines Jean-Michel Molina. Involving the patient as an actor in research was a major element. The publication also contradicts the detractors of PrEP: the use of this preventive method has no impact on the proportion of men who engage in risky sexual behavior.
Officially recommended
The results are convincing and they come with quite a few side effects. Men on antiretroviral therapy had slightly more gastrointestinal (14%) and kidney problems (18%) than those on placebo. The National Medicines Safety Agency (ANSM), which already had these results, seized the opportunity to fly. She announced this 1er December establishment of the Temporary Use Recommendation (RTU) for Truvada in PrEP. The measure will be effective in early 2016.
“We must now see if we can really succeed in reducing the risk of contamination,” said Professor Molina. For that, interested people must come and seek this method of prevention. This is why we offer a consultation: this treatment requires follow-up, but also regular screening. “
France is not the only one to be convinced of the value of this approach. “These studies definitively show (…) that PrEP can be started in a way that is both acceptable to patients, and safe and effective to prevent HIV transmission,” write Anthony Fauci and Hilary Marston of the American Institute of Allergies and Infectious Diseases (NIAID) in a perspective.
The reference preventive measure, however, remains the wearing of a condom. PrEP will remain a complementary measure, reserved for the most exposed populations.
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