London - Britain’s NHS “cannot afford to ignore” a daily pill that dramatically lowers the risk of infection with HIV, the experts behind a groundbreaking trial have said.
The drug, Pre-exposure prophylaxis (PrEP), has been described as a “game changer” by HIV and Aids researchers after a UK study found it cut infections by 86 percent 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 US, and the NHS is now assessing whether it can be offered free to high-risk groups. A decision is expected early in 2016, but early studies by suggest targeted prescriptions of PrEP could 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.”
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 (about R198 000) per year, and would also have to clarify the criteria for qualifying for a free PrEP prescription.
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.
Because it is a specialist HIV drug, a final decision on PrEP will rest with NHS England not Nice (the National Institute of Health and Care Excellence).
Dr Ian Williams, chair of the HIV clinical reference group for NHS England, said: “Consideration is already being given to how best to make further progress.”
The Independent