- Pre-exposure prophylaxis and post-exposure prophylaxis in high risk
groups to prevent HIV infection may be more cost effective than
antiretroviral therapy (ART) of active HIV cases
- Although HIV is now considered a manageable condition since the
advent of ART, new cases are also increasing due to continued high risk
behavior among people
- Currently, there are no effective vaccines or control measures to
prevent HIV infection in high risk groups.
New Canadian guidelines state that measures to prevent HIV infection in high
risk populations, such as pre-exposure and post-exposure prophylaxis may
actually be more cost effective
than treating active HIV infections
. The guidelines appear in CMAJ
(Canadian Medical Association Journal)
in November 2017 and targets
high risk individuals who indulge in risky sexual behavior and IV drug users
According to Dr. Darrell Tan, an
infectious diseases physician and researcher at St. Michael's Hospital,
Toronto, Ontario, and his team, "The large financial cost of HIV infection
and the young age of those newly diagnosed (most new cases occur in those aged
30 to 39 years) underscore the economic and social importance of preventing new
‘Latest guidelines on pre and post-exposure prophylaxis to prevent HIV infection in high risk groups may bring down incidence of HIV in Canada.’
Development of Guidelines for
Prophylaxis - Key to Prevent HIV in High Risk Groups
- Nearly half (54%) of all newly
diagnosed infections in Canada occur in gay, bisexual and men who have sex with men (MSM), a high risk
group in whom the estimated risk of infection is 131 times higher than
drug users have been estimated to have 59
times more risk to get HIV than nonusers.
- Persons from countries where HIV is endemic, namely some African countries
are 6.4 times more likely to become infected
Canadians are also at higher risk (2.7 times more),
compared to the general Canadian population.
The above population belong to the high risk groups
in whom HIV prevention is aimed.
- The guidelines for pre-exposure and
post-exposure prophylaxis were developed by the Biomedical HIV Prevention
Working Group of the CIHR Canadian HIV Trials Network with a panel of 24
experts from diverse disciplines.
- These guidelines generally conform to international guidelines
followed in the USA, UK and Australia.
- The guidelines are aimed at health care personnel from
different disciplines like primary care, infectious diseases, emergency
medicine, nursing, pharmacy and others.
strategies are explained with easy reference boxes giving practical advice
on prevention of HIV infection.
- The guidelines may also be useful to policy makers who
draft important decisions on health and public welfare.
The authors of the study state, "We
hope that this guideline will contribute
to reducing HIV incidence in Canada by improving the quality of care,
increasing access to care, reducing inappropriate variation in practice
promoting the rigorous evaluation of biomedical prevention strategies
and Post-exposure Prophylaxis - Safe and Cost Effective
prophylaxis or PrEP refers to a method to
prevent HIV infection in persons who do not have HIV but who are at
significant risk of getting it, by taking antiretroviral pill every day
even before possible exposure occurs.
postexposure prophylaxis (nPEP) refers to taking
a course of antiretroviral
medications to prevent infection, after being
potentially exposed to HIV, following sexual or drug associated exposure.
According to the authors, the medications
used as PrEP and nPEP are generally very
effective and safe
. However, occasionally these regimens may not suit all
people at increased HIV risk, either due to personal choice or incidence of
adverse effects. Health economic analyses show that targeting PrEP in high-risk populations is cost-effective in terms of
health care spending
than the cost of HIV treatment.
"To date, medication costs have also
restricted the feasibility and acceptability of these strategies," write
the authors. "However, the recent
introduction of generic TDF/FTC [the anti-HIV medication
approved for use
as PrEP in Canada and a major component of all nPEP regimens] and the
increasing availability of public drug coverage for PrEP in Canada may have
substantial effects on their uptake."
Practised Preexposure Prophylaxis Norms in the US
- The pill (brand name Truvada)
administered as prophylaxis is a combination
of two medicines (tenofovir and emtricitabine) that is used with other
medicines to treat HIV.
- When taken regularly PrEP has been
shown to reduce the risk of infection by as much as 92%
- Additionally, when
used in combination with other measures such as use of condoms, education
about reducing risky practices, and voluntary circumcision, PrEP can prove
to be a very powerful tool in HIV
- It is very important though that the
person commits to taking the drug every day and follows up with the health
care worker every three months.
Persons who may be Considered for Preexposure Prophylaxis
- If you sometimes have sex without
using a condom, especially if the partner has known HIV infection.
- If you do not know whether your
partner has HIV infection but you know that your partner belongs to a high
risk group (for example, your partner is an intravenous drug user or has
sex with other people too).
- If you have recently been diagnosed
with a sexually transmitted infection.
- If your partner has HIV infection,
PrEP may help in protecting you from becoming infected especially if you
are trying to become or are already pregnant or breastfeeding.
be started within 72 hours after a possible recent exposure
to HIV (for
example sexually assaulted, broken condoms, shared needles), but the sooner you
start PEP, the better. Every hour counts.
must be taken once or twice daily for 28 days
and is effective in
preventing HIV although not 100%.
- Pre- and post-sexual exposure prophylaxis of HIV: An update - (https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/post-exposure-prophylaxis)
- Pre-Exposure Prophylaxis (PrEP) - (https://www.cdc.gov/hiv/risk/prep/index.html)
- PEP - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389206/)