The NHS “cannot afford to ignore” a daily pill that dramatically lowers the risk of infection with HIV, the experts behind a ground-breaking trial have said.
Pre-exposure prophylaxis (PrEP) has been described as a “game-changer” by HIV/AIDS researchers, after a UK study found it cut infections by 86 per cent among gay men at high risk.
A trial taking place at 13 sexual health clinics was accelerated last year after it became clear the drug was highly effective. Now, final results published in The Lancet suggest that, among men considered to be at high risk of infection, one case of HIV could be prevented for every 13 men taking PrEP.
The pill used in the trial, Truvada, is already available in the USA, and the NHS is now assessing whether it can be offered for free to high risk groups.
A decision is expected early in 2016, but early studies by independent experts suggest targeted prescriptions of PrEP could potentially save the NHS money in the long-term, because of an anticipated fall in HIV infections and the costs of treating them.
In the Lancet paper, researchers involved with the English trial – known as PROUD – led by Professor Sheena McCormack of the Medical Research Council clinical trials unit at University College London (UCL), said there had been no significant increase in other sexually transmitted infections among the trial group – alleviating concerns among some experts that PrEP use would lead to significant increases in risky sexual behaviour.
They conclude: “National health services are under financial constraints, but they cannot afford to ignore the results of PROUD and [separate PrEP trial] IPERGAY, which strongly support the addition of PrEP to the current standard of prevention for men who have sex with men at risk of HIV infection.”
Read more: HIV status of nearly 800 patients accidentally disclosed
HIV positive teenager in remission for 12 years despite no treatment
HIV breakthrough: New treatment shows extraordinary results
The number of new HIV infections in the UK has not fallen for a decade, with around 3,250 new cases in 2013.
Any decisions about cost-effectiveness will have to take into account the high cost of treating HIV infections, which can be as high as £11,000 per year, and would also have to clarify the criteria for qualifying for a free PrEP prescription.
Activists light candles on World Aids Day in Manila. HIV infection rates have remained high in Britain for a decade (Getty)
Research led by Valentina Cambiano at UCL suggests that prescribing Truvada, at a cost of £4,300 per patient per year, to around 7,000 men at highest risk – those who have had unprotected sex with five partners in the past year – could save the NHS £500m over 80 years. However, it is hoped that more men could be granted access to the drug, and to be cost-effective the price of Truvada may have to come down.
The cheaper the drug, the more men who could be prescribed it without incurring a long-term cost to the NHS.
Because it is a specialist HIV drug, a final decision on PrEP will rest with NHS England not the National Institute of Health and Care Excellence (NICE).
Dr Ian Williams, Chair of the HIV clinical reference group for NHS England, said: “We want to see reductions in new transmissions of HIV infection and are already investing in programmes to achieve this.
“These findings add to existing international evidence on preventing infection, and consideration is already being given to how best to make further progress.”
Dr Michael Brady, medical director of sexual health charity the Terrence Higgins Trust said: “Like HIV treatment, the history of HIV prevention has evolved over time. A ‘combination approach’ to HIV prevention is possible, and we need access to PrEP now.”
