PrEP is a vital component to HIV Treatment
Following recent commentary in the Irish media1 regarding the safety of antiretrovirals in the treatment of HIV infection, we invited Dr Paddy Mallon to offer his perspective on the importance of pre-exposure prophylaxis (PrEP) as part of the disease management strategy. Dr Mallon is a consultant in infectious diseases at the Mater Misericordiae University Hospital and Director of the HIV Molecular Research Group at the UCD School of Medicine. He has nearly 20 years experience in the clinical management of people living with HIV in both Dublin and Sydney.
The management of HIV infection has progressed considerably over the past 15 years and the vast majority of people living with HIV in Ireland now access safe and effective treatment that has resulted in many now realising the opportunity to lead healthy lives. To describe modern antiretroviral therapy as ‘highly toxic’ is an irresponsible misrepresentation of facts that could raise unnecessary concerns for those thousands of people in Ireland currently living with HIV.
The drug referred to within the article (Truvada) has formed the backbone of effective therapy for those with HIV for more than a decade and, contrary to what the article suggests, has not been identified as a cause of abnormalities in fat distribution. Similarly, the author asserts that use of Truvada for pre-exposure prophylaxis (PrEP) could be responsible for ‘widespread liver disease among gay populations in 10-15 years’, a statement simply not supported by any evidence; in fact one component of Truvada (tenofovir DF) is actually used internationally to treat hepatitis B.
With regards to use of PrEP, the author suggests that additional information is required on long-term side effects and its effectiveness before we should consider its use in Ireland. In fact, the European Medicines Agency approved use of Truvada in HIV prevention based on a wealth of data in this area, including two large European clinical trials that both demonstrated that adding PrEP to existing prevention strategies (such as increased testing and use of condoms) resulted in a further 85% reduction in HIV transmission, with no unexpected safety signals, has been available for general use in the US for several years and is increasingly being introduced by other governments in Europe.
With 2016 data from the Health Protection Surveillance Centre showing new HIV diagnoses in Ireland exceeding 500 for the first time in many years, there is clearly an urgent need for better HIV prevention in the Irish setting.
Contrary to the author’s perception, in the two decades that I have been involved in HIV care, both in Dublin and in Sydney, I have never seen the gay, lesbian and transgendered community more engaged in taking responsibility for their own sexual health, through their vocal and active lobbying for access to the range of prevention tools that have been clearly shown internationally to be safe, acceptable and effective at reducing the risk of HIV transmission.
I think we all need to recognise that use of fear-based education as a public health tool in sexual health simply has not worked in Ireland, as reflected not only by rising HIV notifications but also increased gonorrhoea diagnoses among younger women and the ongoing problem with high rates of syphilis. The time really has come for the government to take some meaningful action based on the wealth of evidence that is already available.
Whilst I welcome dialogue and discussion on use of PrEP in HIV prevention in Ireland, including discussion about the current realities of condom use within the population in general, opinions should be based on accurate facts.
Dr Mallon is Director of the HIV Molecular Research Group at the UCD School of Medicine and consultant in infectious diseases at the Mater Misericordiae University Hospital. This article was written in response to an opinion piece by Derek Byrne published by the Irish Times.
1. Anti-HIV Drug removes personal responsibility, Derek Byrne, Irish Times Opinion & Analysis, 21st April 2017