Prevention options

The efficacy of pre-exposure prophylaxis (PrEP) is examined in the latest edition of HIV Australia, and Burnet Institute researcher Dr Clovis Palmer contributes with a round up of current research and debates.

PrEP is the use of anti-HIV medication, Truvada, taken daily as a single pill to keep HIV negative people from becoming infected.

Reduces HIV risk by up to 92 per cent

When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 per cent, but it’s not without issues.

“There’s a huge debate about whether Australians should be taking PrEP as a preventative strategy for high-risk behaviour, especially men who have sex with men,” Dr Palmer said.

“The concern is whether it’s going to increase unsafe sex, which would increase the risk of acquiring other STIs, and there’s the question of the development of drug resistance and whether this would spread.

“Also there are side effects, and whether these are long-term is still a debate. I think people should be aware of them, because some people are in denial.”

Dr Palmer said the purpose of his article was to canvass issues around PrEP, flag the downsides and proffer solutions, such as how to improve the roll out.

Supplements could limit potential side effects

“In one example I highlight the problem of PrEP with kidney disease and bone disease, because research has shown that Truvada can affect the bones and kidneys,” Dr Palmer said.

“I highlight a study in America which looks at whether you can give people vitamin D along with calcium supplements to limit the negative effects of PrEP."

Dr Palmer also looks at longer-lasting alternatives to the daily regimen that PrEP demands.

“People have to take PrEP every day, pretty much like people infected with HIV, and the problem will arise whether or not people will take it every day,“ he said.

“There are now some long-acting drugs, cabotegravir for example, where you could potentially give the person an injection for a month as a preventative.”

“PrEP is an exciting development, and it’s a way to move forward, but there are a lot of drawbacks.

“The question is, how can we take what we have now and move forward