- Category: Pre-exposure Prophylaxis (PrEP)
- Published on Wednesday, 16 July 2014 00:00
- Written by Liz Highleyman
Gay and bisexual men who are at risk for HIV infection should consider using antiretroviral drugs for pre-exposure prophylaxis (PrEP), according to new guidelines from the World Health Organization (WHO), part of a set of recommendations for key populations affected by the HIV/AIDS epidemic.
Noting that HIV infection rates among gay and bi men remain high almost everywhere and new prevention options are urgently needed, WHO strongly recommended that men who have sex with men consider taking antiretroviral drugs as an additional method of protection along with condoms.
The WHO recommendation is similar to U.S. Centers for Disease Control and Prevention guidelines released in May, which state that healthcare providers should consider advising people at "substantial risk" to use PrEP to prevent HIV infection.
"The CDC and WHO recommendations should put to rest the harmful efforts of community members and medical providers who would deny people the right to choose PrEP in order to protect their health," said Dana Van Gorder, executive director of Project Inform. "Armed with these sound and important WHO and CDC recommendations, people who want to start PrEP are in a superior position to advocate for what they believe is the right prevention intervention for them."
The U.S. Food and Drug Administration approved Gilead Sciences' Truvada combination pill for PrEP in July 2012. The 2 drugs in Truvada, tenofovir and emtricitabine, have been approved for HIV treatment for more than a decade and are considered safe and well-tolerated. Tenofovir can cause impaired kidney function and bone loss in some people, but so far it has shown minimal side effects in PrEP studies.
The international iPrEx trial found that daily use of Truvada reduced the risk of HIV infection for gay and bisexual men and transgender women by 42% overall, rising to more than 90% among participants with blood drug levels indicating regular daily use. Mathematical models estimate that widespread use of PrEP could reduce HIV incidence among men who have sex with men by 20-25% worldwide, preventing up to 1 million new infections, according to WHO.
"The WHO recommendation for PrEP for men who have sex with men is extremely important," said iPrEx lead investigator Robert Grant from Gladstone Institutes in San Francisco. "These recommendations highlight how HIV uninfected people can play an important role in getting to zero transmissions. These medications have a proven record of safety and effectiveness for treatment and prevention."
The PrEP recommendation was included in new guidelines for HIV prevention, diagnosis, treatment, and care for key populations, released ahead of the 20th International AIDS Conference starting Sunday in Melbourne, Australia.
"Failure to provide adequate HIV services for key groups -- men who have sex with men, people in prison, people who inject drugs, sex workers and transgender people -- threatens global progress on the HIV response," WHO warned in a press release accompanying the recommendations. "These people are most at risk of HIV infection yet are least likely to have access to HIV prevention, testing, and treatment services. In many countries they are left out of national HIV plans, and discriminatory laws and policies are major barriers to access."
"None of these people live in isolation,” said Gottfried Hirnschall, director of the HIV Department at WHO. "Sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children. Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and wellbeing of individuals, their families and the broader community."
World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. July 2014.
World Health Organization. WHO: People most at risk of HIV are not getting the health services they need. Press release. July 11, 2014.