Virtually no risk and less stress on PrEP
There is no sign of an increase of risky behaviour in men and transgender women who have sex with men among PrEP users, and those taking it consistently have virtually zero risk of acquiring HIV, a new study has shown.
The iPrEx OLE study, released last week during the AIDS 2014 Conference, is the first demonstration project on the experience of those using pre-exposure prophylaxis (PrEP), the drug used by HIV negative people to prevent becoming infected with HIV.
"We had been concerned that people taking PrEP might stop using condoms or have more sexual partners, but we did not see any evidence of risk compensation," said Dr Robert Grant, Protocol Chair of the iPrEx studies, and Senior Investigator at the Gladstone Institutes.
"Even though everyone in the study knew they were on PrEP, knew it was effective, and knew it was safe, we still see trends towards safe sex behaviour," Dr Grant said.
In fact, the only change in sexual behaviour was found in younger people, who were more inclined to use condoms more often.
"We have terrible sex education in the United States, and we attribute the increased condom use to the increased counselling the participants received during the study", said Kimberly Koester, researcher at Center for AIDS Prevention Studies, Department of Medicine, University of California.
Further to this, benefits of those who were on PrEP included a decrease in stress, guilt and fear around sexual practices.
"We learnt that PrEP has created a space for men to voice their deeply felt fears about becoming infected with HIV, and for many prep has become an antidote to those fears," Koester said.
This month, the World Health Organisation (WHO) strongly recommended that all men who have sex with men consider taking PrEP as an additional measure to prevent HIV infection.
"Modelling estimates that, globally, 20-25 percent reductions in HIV incidence among men who have sex with men could be achieved through pre-exposure prophylaxis, averting up to 1 million new infections among this group over 10 years," WHO added.
The study also found that no participant who took PrEP four or more times per week became HIV-infected, suggesting skipping the pill for one or two days a week does not decrease the resistance to HIV substantially and increase the risk of infection.
"Daily dosing of PrEP is recommended, because it helps foster the habit of consistent PrEP use and increases drug levels in the body, providing the best safety cushion for individuals who occasionally miss doses," Dr Grant said.
Researchers are hoping the prevention strategy pill will become more readily available, with the pill free for people in the state of Washington, with New York and California on their way to making PrEP more accessible.
Here in Australia, PrEP is in its development study trial stages in Victoria and New South Wales.
The iPrEx OLE study included 1603 men and transgender women who were offered PrEP for 72 weeks, and was conducted in cities in Peru, Brazil, the US, South Africa and Thailand.