Amsterdam, 18 July 2011 – Preliminary results from two large studies have now shown that a daily antiretroviral tablet taken by people who do not have HIV reduces their risk of contracting HIV by up to 73%. The Partners PrEP trial involved 4758 HIV-discordant couples in Kenya and Uganda. The TDF2 trial involved 1219 men and women in Botswana.
The studies looked at both tenofovir or tenofovir plus emtricitabine (Truvada) and found that each, when taken in advance by the HIV-negative partner as a pre-exposure prophylaxis (PrEP), can prevent heterosexual transmission of HIV from men to women and from women to men.
“The results of these studies highlight yet again the essential role of affordable ARVs in prevention. They are a major breakthrough allowing a new vision on current prevention efforts,” says Kevin Moody, International Coordinator and CEO of the Global Network of People Living with HIV. “Recently we learnt from the HPTN052 study that antiretrovirals taken by people living with HIV reduce the risk of HIV transmission to the HIV-negative partner. Now we have evidence of an additional ARV-based prevention tool that allows a person not living with HIV to protect themselves from contracting HIV.”
The full potential of this new HIV prevention tool will only be realised once cost is not a barrier to access. Provision of antiretrovirals for PrEP must not come at the expense of scaling up treatment programmes for those who do need treatment. Furthermore, consideration must be made of how to deliver PrEP and monitor the health of people taking it, especially in settings with overburdened health systems.
GNP+ calls on the World Health Organization and Joint United Nations Programme on HIV/AIDS to ensure guidance is developed and published for individuals and couples on how to make informed decisions about the HIV prevention options that work best for them, as well as guidance for those providing services to those in need to access ART and PrEP. This guidance should be developed in collaboration with networks of people living with HIV and key populations. Information about the benefits and risks involved in taking antiretrovirals, and skills to discuss and negotiate the various options, are essential for good adherence to both prevention and treatment.
Serious concerns remain about the long-term health effects for HIV-negative people when taking antiretrovirals for HIV prevention. The studies now published used standard daily doses of tenofovir and Truvada, but more research is needed to determine whether lower doses or intermittent dosing might be as effective and if they may improve long-term safety, adherence and reduce costs.
The impact PrEP might have on ARV resistance is yet to be determined, but it is likely that people unaware that they are already living with HIV will develop resistance when taking PrEP. To better manage this risk, there should be dramatically increased access to high quality human rights-based HIV testing, counselling and support services, since individuals taking PrEP will need to test on a regular basis. In-depth and ongoing research remains necessary in order to support individuals and couples to make informed decisions.
In jurisdictions where HIV exposure and/or transmission are criminalised, the use of antiretrovirals for HIV prevention by either HIV-positive or HIV-negative people, or both, potentially transforms the ethical and legal landscape in terms of ‘shared responsibility’ to prevent new infections. Supportive policy and legal environments are essential to enable individuals living with HIV, as well as those at risk of HIV from key population groups, to benefit from the full potential of these new prevention technologies, without fear of (further) criminalisation.
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