Viewpoint: HIV drug battle

Prescription drugs, close up

Molecular and Clinical Pharmacology Professor Saye Khoo from the University’s Institute of Translational Medicine comments on the High Court ruling regarding the NHS’ funding of a drug that can help prevent HIV.

“The high court ruling that Pre-exposure prophylaxis (PrEP) can be funded by NHS England (if it so chooses) is the latest twist to a long and complex saga.

“PrEP is a course of HIV drugs taken before sex to reduce the risk of getting HIV. PrEP is intended for people who are at high risk of getting HIV. This would include those in a relationship with an HIV positive partner.

“The biological proof that PrEP can prevent HIV infection is well-established, yet some large trials of PrEP across diverse groups failed to show any benefit: this was almost certainly related to lack of adherence to daily drug dosing.

“The UK PROUD study was one of two landmark trials to conclusively demonstrate the real-world effectiveness of PrEP in a targeted high-risk group of gay men. The level of protective efficacy (86%) was unanticipated, and the numbers needed to treat to prevent a new infection offered robust evidence of value for money for NHS England whose current budget for HIV treatment is £770M.

“Consequently, PrEP has been implemented in the US, Canada, France and Australia, although not yet in the UK. PrEP costs around £400/month and given the strong impact of adherence, needs to be targeted.

“Investigators from the University of Liverpool were amongst the PROUD investigators, and undertook drug measurements in the Bioanalytical Facility to confirm that drug intake amongst PROUD participants was good.

“For maximal cost-effectiveness, PrEP should be deployed alongside strategies to assess, and support good adherence to medication.”

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