Monday, July 14, 2014

WHO Clarifies Their Advice For Considering PrEP HIV Antivirals

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Credit WHO

 

# 8833

 

On Friday the World Health Organization issued a news release entitled:

 

WHO: People most at risk of HIV are not getting the health services they need

News release

11 July 2014 ¦ Geneva - Failure to provide adequate HIV services for key groups – men who have sex with men, people in prison, people who inject drugs, sex workers and transgender people – threatens global progress on the HIV response, warns WHO.

These people are most at risk of HIV infection yet are least likely to have access to HIV prevention, testing and treatment services. In many countries they are left out of national HIV plans, and discriminatory laws and policies are major barriers to access.

WHO today released "Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations", in the lead-up to the International AIDS Conference in Melbourne, Australia, starting on 20 July.

Steps to reduce new HIV infections

The guidelines outline steps for countries to reduce new HIV infections and increase access to HIV testing, treatment and care for these five ‘key populations’*. They include a comprehensive range of clinical recommendations but, for these to be effective, WHO also recommends countries need to remove the legal and social barriers that prevent many people from accessing services.

For the first time, WHO strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection (pre-exposure prophylaxis)** alongside the use of condoms. Rates of HIV infection among men who have sex with men remain high almost everywhere and new prevention options are urgently needed.

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This preventative strategy is known as PrEP, or pre-exposure prophylaxis.

 

Although far from the only point being made in this statement, the recommendation that `. . . men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection. . . ’  made a big splash in the mass media over the weekend.

 

The Altantic ran with the headline The WHO Wants All Gay Men to Take HIV Prevention Medication  while Time Magazine went with WHO Says All Men Who Have Sex With Men Should Take Antiretroviral Drugs
 

 

The problem being, the idea that all gay men take PrEP isn’t exactly the message the WHO was trying to convey.  First their (emailed) clarification, and then I’ll be back with the CDC’s recommendations for Pre-Exposure Prophylaxis against HIV.

 

Clarification: WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations 

WHO is aware of incorrect headlines and reporting linked to its recent recommendations on pre-exposure prophylaxis (PrEP) for HIV.


WHO is not recommending that all men who have sex with men must take PrEP, but supporting it as an additional choice (see paragraph 5 of the WHO news release http://www.who.int/mediacentre/news/releases/2014/key-populations-to-hiv/en/):

For the first time, WHO strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection (pre-exposure prophylaxis) alongside the use of condoms.

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV, but who are at risk of getting it, to prevent them getting HIV by taking a single pill (usually a combination of two antiretrovirals) every day.  PrEP, when taken consistently, has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. PrEP is much less effective if it is not taken consistently.

Rates of HIV infection among men who have sex with men remain high almost everywhere and new prevention options are urgently needed.

Further information on the development of this recommendation can be found here:

http://apps.who.int/iris/bitstream/10665/128114/1/WHO_HIV_2014.9_eng.pdf?ua=1


The new WHO consolidated on key population guidelines include a comprehensive range of recommendations for five key populations - from HIV prevention (including PrEP as an additional prevention choice), diagnosis and a full range of recommendation on all aspects of care and treatment. The guidelines also outline the critical enablers needed to addressed to allow people from key populations to access the services they need in a respectful, inclusive non-discriminatory way.

For more information, contact:

Melbourne:
Glenn Thomas
WHO Communications
Mobile: +41 79 509 0677
Email:
thomasg@who.int


Geneva:
Tunga Namjilsuren
Information Manager
Telephone: +41 22 791 1073
Email:
namjilsurent@who.int

 

Although it didn’t make as big of splash in the media, last May the CDC issued their own guidelines on the use of PrEP for HIV prevention.  The new federal guidelines recommend that PrEP be considered for people who are - HIV-negative and at substantial risk for HIV and lists some very specific categories.

For sexual transmission, this includes anyone who is in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous* relationship with a partner who recently tested HIV-negative, and 2) is a

  • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD  in the past 6 months; or
  • heterosexual manor woman who does not regularly use condoms during sex with partners of  unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).

For people who inject drugs, this includes those who have injected illicit drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months.

Health care providers should also discuss the use of PrEP with HIV discordant heterosexual couples (in which one partner is HIV-positive and the other HIV-negative) during conception and pregnancy as one of several options to protect the partner who is HIV-negative.

You’ll find a lot more information at the link below:

 

Pre-Exposure Prophylaxis (PrEP)

Pre-exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.

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%. PrEP is much less effective if it is not taken consistently.

PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every 3 months.

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