March 1, 2012
A position statement by the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) has concluded that as yet the data on the efficacy of pre-exposure prophylaxis (PrEP) is not compelling enough for it to be offered to patients on demand, and that it should only be prescribed in the context of a clinical research study until more data on its efficacy is gathered.
The BHIVA/BASHH position contrasts with that of the US Centers for Disease Control, which issued guidance for doctors prescribing PrEP to patients last year.
The two UK organisations, which represent HIV and STI healthcare workers respectively, conducted a consultation on PrEP last year which included in-person and telephone conferences with a variety of UK treatment and prevention stakeholders in the UK (including NAM), and the creation of an ongoing PrEP Working eGroup.
The finalised position statement notes that in 2010 there was the highest-ever number of new HIV infections in gay men in the UK (over 3000, 81% acquired here) and adds that this “continued increase in infections…underscores the urgent need to…rethink our overall strategy for HIV prevention at a time when the NHS is undergoing change.”
It also however notes that the data on the efficacy of PrEP has so far been widely disparate (see Aidsmap reports on the iPrEx, PartnersPrEP, TDF2, FemPrEP and VOICE trials), in contrast to convincing evidence both for the efficacy of condoms when used consistently and correctly and of treatment as prevention.
It also notes that these are many unanswered questions in the case of PrEP: will it be affordable and cost-effective? Will it increase the likelihood of drug resistance? Are there long-term toxicity concerns for HIV-negative people taking it? And will it induce people to abandon condom use? It also notes there has never been a systematic evaluation of behaviour-change programmes in the UK, also in contrast to the US.
It concludes that “it is imperative to gather [more] evidence for the value of PrEP in the UK” and that therefore “We recommend that ad hoc prescribing is avoided, and that PrEP is only prescribed in the context of a clinical research study”. Until then, “regular HIV testing, the diagnosis and treatment of other STIs, and intensive health promotion activities…should be implemented in preference to PrEP.”
McCormack S, Fidler S, Fisher M. The British HIV Association/British Association for Sexual Health and HIV position statement on pre-exposure prophylaxis in the UK. International Journal of STDs and AIDS 23:1-4. DOI: 10.1258/ijsa.2100.051211. 2012.