HIV prevention finally has a game-changer, and it’s called Truvada

‘The study for HIV drug Truvada was the most successful PrEP trial ever.’ Photograph: Justin Sullivan/Getty

Thursday 26 February 2015

The widely reported Proud study shows just how effective pre-exposure prophylaxis (PrEP) can be at preventing HIV transmission. PrEP is, quite simply, a game-changer and represents a wake-up call for the government, NHS England and local authorities to make PrEP a key component in our strategy to defeat HIV

Over the past 30 years of the HIV epidemic in the UK, we have seen enormous change for the better, mostly driven by the increasing range of effective antiretroviral therapies. Their success means that HIV should no longer be a terminal illness but a manageable long-term condition; people on successful therapy with fully suppressed virus can expect a normal life expectancy and are not infectious to others, and we can reliably prevent mother-to-child transmission of HIV.

All this has led to an increasing interest in the possibility of using antiretroviral therapy more widely as a prevention strategy to protect those who are HIV negative. PrEP – using HIV therapy before sex that might carry a risk of HIV transmission – has already been studied in both gay men and heterosexuals in a number of settings with varied success. The fact that the Proud (pre-exposure option for reducing HIV in the UK: immediate or deferred) study in the UK found an 86% reduction in HIV transmission in those taking the drug Truvada makes it the most successful PrEP trial ever, and should now galvanise us into adding it to existing HIV prevention strategies.

Proud was designed to try and evaluate the impact of PrEP in a high-risk group of gay men in a way that reflected “real life” use of the drug as closely as possible: 545 men were randomly allocated to either take Truvada straight away or to defer treatment for a year. Both groups then had regular three-monthly clinic visits, completed questionnaires on sexual behaviour and adherence to the medication, and were tested for sexually transmitted infections. The study found no difference in reports of condom use between the two groups and no difference in rates of other STIs either. This should lay to rest the view that access to PrEP would somehow encourage an increase in risky sexual behaviour.

Related: Daily pill Truvada cuts spread of HIV by 86%, study shows

An 86% reduction in HIV transmission is hugely significant. On the basis of the Proud results we would only need to treat 13 men for a year to prevent one HIV infection. It is hard to see how PrEP would not be value for money. Truvada costs just £360 a month, and the price will drop significantly when the drug comes off patent in a couple of years, whereas the lifetime treatment cost to the NHS of someone living with HIV can be up to £350,000.

The history of HIV prevention has evolved over time just as much as its treatment. A “combination approach” to HIV prevention will undoubtedly yield the greatest success. Those at risk need a range of options and choice to best meet their individual needs and circumstances. It is clearly now time for us to use PrEP alongside other effective prevention interventions such as condom use, behaviour change and regular testing for HIV.

This is a wake-up call and it is imperative that policymakers, commissioners and those who hold the NHS purse strings make PrEP available to those at greatest risk as soon as possible. If we take bold action now, we have the tools at our disposal to make HIV in the UK a thing of the past.