NEW ORLEANS – Efforts to scale up access to pre-exposure prophylaxis (PrEP) for patients at risk for HIV are sorely needed, according to several featured speakers at the IDWeek 2016 annual meeting.1

“We need to scale up access to PrEP now,” Carlos Del Rio, MD, of Emory University Rollins School of Public Health, told a group of physicians at a presentation during the meeting.

Dr Del Rio, along with Pablo Tebas, MD, who is the chair for the HIV Medicine Association’s ID Week panel, noted that there is a huge gap between those individuals at risk for infection and those who are actually receiving PrEP.

Dr Tebas and Dr Del Rio noted that beyond getting patients increased access to PrEP, adherence to treatment is a key issue. To hear more about this issue, watch the video below of Dr Tebas discussing key studies with Infectious Disease Advisor advisory board member and HIV Advisor Channel section editor, Michael Tapper, MD. 

As part of his discussion, Dr Del Rio highlighted several recently-published papers that demonstrated varying degrees of success with new prevention efforts.

Dr Del Rio discussed a study presented earlier this year by Jared Baeten, MD, et al, at the Conference on Retroviruses and Opportunistic Infections that examined the use of a vaginal ring containing dapivirine to prevent HIV in women.2 

Although Dr Del Rio noted that the effect was “modest,” with a 27% reduction in HIV infection among women in sub-Saharan Africa, he said the study raised an important issue that plagues physicians who are trying to prevent HIV: adherence. He noted that the researchers in that study showed no efficacy in women younger than age 21, but the effects were shown in women older than age 21. The message, Dr Del Rio noted, is that “if you are adherent to the drugs you are prescribed or the rings you wear, they work, if you don’t, they won’t.”

For more information on this study, please see the video below that features Dr Baeten discussing their results with Dr Tapper.

A study by Jean-Michel Molina, MD, and colleagues noted the success of on-demand PrEP. Dr Molina et al looked at data on demand PrEP in a cohort of 400 men at high risk for HIV-1 infection in France and Canada.3 

An 86% risk reduction was noted among men who had unprotected anal sex with men, according to the multi-center study. The researchers assigned 199 participants to a median of 15 emtricitabine and tenofovir disoproxil fumarate (Truvada, Gilead) pills per month, and 201 participants to placebo.

The study noted 2 new infections in the group that received HIV prophylaxis, as opposed to 14 in a placebo group.

Dr Molina told Dr Del Rio that the main message of their paper is that “on demand PrEP  works very well,” and he said, physician guidance is key on starting and stopping PrEP.

References

1.      Del Rio C. What’s hot in HIV clinical research? Symposium 6. Presented at: ID Week 2016. Oct. 26-30, 2016. New Orleans.

2.      Baeten JM. 109LB. A phase 3 trial of the dapivirine vaginal ring for HIV-1 Prevention in Women. Presented at: CROI 2016. Feb. 22-25, 2016. Boston.

3.      Molina JM, Capitant C, Spire B et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015; 373:2237-2246.