NHS may reconsider axeing HIV prevention drug

England’s National Health Service may after all fund a HIV medicine which can prevent transmission of the disease in at-risk groups, after fears about budget cuts.

So-called pre-exposure prophylaxis (PrEP) is possible if individuals take Gilead’s Truvada (emtricitabine+tenofovir), but NHS England had signalled that it would not fund a nation-wide programme.

In March, NHS England said it had decided to drastically reduce its plan to fund the drug in PrEP, where the medicine is taken to prevent transmission of the disease in at-risk groups.

The PROUD study, published in The Lancet last autumn, made the case for national roll-out of PrEP, using real-world data from clinics in England to show that Truvada conferred even higher protection against HIV than in placebo-controlled trials.

PROUD refuted concerns that the drug would be less effective outside of clinical trials, and found no evidence of an increase in other sexually transmitted infections.

Amid anger from patient groups, NHS England said it had shelved plans for a national scheme, instead saying it will earmark £2 million over the next two years to run “a number” of “implementer test sites”.

But NHS England has changed its mind, saying that a final decision is due in late May, following a legal challenge from the charity, the National AIDS Trust. NHS England referred to a document published in March showing it had made its decision to drop PrEP because local authorities are legally responsible for providing preventative services.

The decision was not based on concerns about effectiveness or its cost, NHS England said, adding that it has now placed this position under review ahead of a final decision on 31 May.

A spokesperson said: “Final decisions on PrEP have not yet been taken, and we have agreed to consider representations from some stakeholders before deciding on next steps on the appropriate way forward.”

Ian Green, chief executive at the charity, the Terrence Higgins Trust, said: “We’ve been working closely with the HIV sector to challenge the earlier shameful decision, following universal outrage after NHS England abandoned its own public consultation process on PrEP. Having written to and met NHS England to discuss this, this U-turn is a promising step in the campaign for HIV prevention. However, we remain sceptical and need answers from NHS England on when access to PrEP will be available to those who need it.”

Around 2,500 men who have sex with men (MSM) are diagnosed with HIV each year in the UK, said Green, meaning that for every day that PrEP access is delayed, seven MSM are diagnosed with HIV every day despite advances in prevention.

“Whilst we are encouraged by this change of heart we will ensure the pressure is maintained. Terrence Higgins Trust continues to work with sector colleagues, the NHS, MPs and Lords, so that PrEP is made available on the NHS to those at high risk of HIV.”

Related stories:

England cuts back plans for Truvada in HIV prevention

Raising the bar: can Gilead’s next challenge be even bigger than hep C?


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