For the first time, a large-scale, real-world study has been conducted to demonstrate the efficacy of HIV prevention drug Pre-Exposure Prophylaxis (PrEP). The results of the study, known as the Impact study, have been published in the journal The Lancet HIV on 1 December 2023. While PrEP has been in use for several years and has been proven to be effective in preventing HIV transmission, experts from India have noted that it is not the sole solution, practicing safe intimate habits is.
It is important to note that PrEP must be administered to individuals at high risk of contracting HIV, as well as to couples with one HIV-positive partner and one HIV-negative partner. Overuse and misuse of PrEP can lead to a shortage of the drug, so it is important to ensure that its effectiveness is not overstated. The Impact study has demonstrated that PrEP is effective in reducing the risk of getting HIV by 86%.
The Impact study
This study is one of the biggest yet, with over 24,000 people taking part in the Impact Trial. It looks at how PrEP is used in England, and it gives us an idea of who is eligible for it, how often it’s taken, and how often it’s used. The study provided accurate estimates of how often people get STI’s and HIV from PrEP users. It was done at 157 sex health clinics in England from October 13, 2017, to July 12, 2020, over a three-year period.
PrEP was always prescribed, but…
Antiretrovirals are available in two forms: PrEP and PEP. These two drugs have been used for a long time and the World Health Organization (WHO) has been recommending them for a long time. However, it is important to note that these two drugs cannot be given to all individuals, says Dr Divya Joshi, consultant, infectious diseases, Fortis hospitals, Bengaluru.
This study did not look at the partners of the participants, but experts from India point out that there is a larger study that was published in 2011 which discussed that PrEP was already very effective in preventing HIV and was recommended by the WHO.
Dr Vinay D, consultant, Infectious Diseases, Apollo Hospitals, Bengaluru said that PrEP is a well-known fact, and this study did not conclude that it was a gold standard in prevention of HIV. The main disadvantage of this prescription, Dr Vinay said, is that individuals will fall back on the use of barrier methods (usage of condoms) as part of safe sexual practices.
“Only using PrEP will not reduce the risk of catching other sexually transmitted diseases (STDs). People need to ensure and be educated that PrEP is not the solution, but following safe sexual practices can keep you at bay from HIV,” he added.
Cultural differences in considering PrEP treatment
Different cultures have different levels of acceptance and stigma associated with HIV. Experts report that many people are not comfortable talking to their doctors about their risky sexual habits, but some people are open about their sexual activities and request PrEP prescriptions from their doctors. But they do not know that it can only prevent HIV and not other sexually transmitted diseases (STDs) like syphilis, chlamydia, hepatitis-B, and HPV, among others,” says Dr Joshi.
“PrEP should only be given to those who are at risk of HIV (like sex workers, transgenders) and not to those who are not affected by HIV,” Dr Vinay said, “If a country provides PrEP for free to everyone, including those who are not HIV-positive, then it makes no sense.”
Dr Joshi also noted that people in India do not usually come out openly and discuss their risky behaviors. “There is not much screening that happens among the population,” she said.
In India, many people are aware of the benefits of PrEP, according to Dr Neha Mishra, consultant-Infectious Diseases, Manipal Hospitals, Bengaluru, who has seen many people come to her asking for PrEP. She states that there are a lot of people who have tried PrEP and that it works well, but people need to be aware that it is only for high-risk individuals, such as sex workers and high-risk individuals.
PrEP is accessible and ART therapies are affordable
It is a common misconception that people who are HIV positive or at risk of becoming HIV positive say that treatment protocols are costly. However, this is not the case, according to Dr Vinay. He says, “Antiretroviral therapy (ART) isn’t expensive. Drug companies have reduced the price of PrEP. The therapy costs Rs. 3000 per 35 days course according to the government’s price cap. The government provides free treatment. There is no question of affordability.”
PrEP: When one partner is HIV+
Dr Ramakrishna Prasad, senior consultant, Infectious Diseases and Family Medicine, Trustwell hospital, Bengaluru says PrEP is recommended for couples who are serodiscordant (where one partner is infected with HIV and other is not).
“If they want to have a baby, then the person who is not HIV positive can take PrEP thereby reducing the risk of exposure to infection. This will also lead to babies not contracting the virus,” he added.
However, experts also say that there should be discipline while taking PrEP. Using substances alcohol, and other drugs can impact its effectiveness.
The story does not end there, Dr Prasad cautions that there is a possibility that even after taking PrEP, one may get infected with resistance virus against which prep may not be effective. Also, “PrEP is a valuable option in HIV prevention but should not be considered as a standalone option and needs to be promoted only with proper counseling and follow ups,” he concluded.
Happiest Health has reached out to Dr Ann Sullivan, chief investigator for the PrEP Impact Trial, consultant physician in Infectious Diseases and HIV at Chelsea and Westminster Hospital NHS Foundation Trust for comments.
With inputs from Ipshita Ghosh
