Two new drug treatments could help to limit transmission of HIV, but are they the best way forward?
With HIV still prevalent in many different groups in the UK, it is only right to ask if we can expect the newly endorsed (by the World Health Organisation) preventive measure of PrEP (pre-exposure prophylaxis) and the 72-hour after-treatment of PEP (post exposure prophylaxis) to be freely available from the NHS. However, with worries about resistance to the drugs developing, and the threat of an ideological change about the necessity of other preventive measures, it is not clear whether Victoria Beckham (the newly appointed UNAIDs International Goodwill Ambassador) will endorse PEP and PrEP or continue with an educational approach to reducing transmission of HIV.
PrEP is a daily pill, which, if taken regularly, can stop the proliferation of HIV in the body in around 92% of cases, as demonstrated in the iPrEx study. With a result as large as this, it was approved by the Centre for Disease Control and Prevention (CDC) in the United States, but is yet to be authorised for use as a preventive measure in the UK. Questions have arisen that are yet to be answered, including what the long-term effects of the treatment are on patients. However, for some patients, specifically those in sero-discordant (mixed HIV-status) relationships, this treatment would be revolutionary in facilitating safe and healthy sexual contact. On the other hand, there is a potential risk of HIV-negative individuals becoming resistant to the drugs, which would vastly complicate their treatment if they were to become HIV-positive.
Currently, there is limited access to PEP (only at sexual health clinics and A&E) and it can be difficult for some to gain access within the 72-hour post-exposure treatment window. PEP is a dense treatment regime that lasts 28 days and doesn’t always work, although there is the potential that easier access to both of these drugs could reduce the rate of people contracting HIV, and therefore lessen the financial burden of HIV on the NHS. However, some argue that the already struggling NHS will not be able to fund the multitudes of drugs that make up a single treatment regime in the short term, in order to benefit from any decrease in disease burden in the future.
Drugs to combat one of the most debilitating and stigmatic diseases in the world are a competitive business, and it will be interesting to see whether or not the UK will decide to take part in it.
By Louie Roberts