NICE review sparks new call for HIV prophylaxis

Campaigners demanding Gilead’s Truvada (tenofovir+emtricitabine) be made available as a HIV prevention medicine in England say a NICE review supports their case.

NICE has published an evidence review – which is not binding guidance – to aid England’s National Health Service as it decides whether the treatment is cost-effective.

Truvada is now approved in Europe for so-called pre-exposure prophylaxis (PrEP), where the drug can reduce infections because it can stop the virus taking hold and spreading through the body.

England’s National Health Service is blocking plans to introduce a national PrEP scheme, but the National AIDS Trust said this week there is a pressing need to reduce infection rates.

Latest government data for 2015 show infection rates are “stubbornly high” at 6,000 per year, the trust said, calling for PrEP to be introduced “as soon as possible”.

Reviewing evidence from four randomised trials, NICE said Truvada reduced relative risk of acquiring HIV infection by between 44% and 86% compared with placebo or no prophylaxis.

The evidence summary says that the provision of PrEP may increase access to other health services such as HIV testing, sexually transmitted infection and hepatitis B screening and support for high-risk sexual behaviour.

Other issues that should be taken into account include uptake and adherence, sexual behaviour, drug resistance, safety, prioritisation for prophylaxis and cost effectiveness.

Deborah Gold, chief executive of the National AIDS Trust, said, “We welcome the publication of the NICE Evidence review on PrEP.  The review sets out the overwhelming evidence for the effectiveness of PrEP in preventing HIV transmission, as well as its excellent outcomes relating to safety and tolerability.

“The NICE review does not look at cost-effectiveness, which is currently being considered by NHS England as part of its specialised commissioning process.  We look forward to the NHS England process continuing and to agreement being reached as soon as possible on the provision of PrEP to those who need it.”

Earlier this year, plans for a national scheme were drastically scaled back to a few pilot sites, because NHS England said it was not legally able to provide preventative health schemes as this lies within the remit of local authorities.

A judge has since ruled NHS England can provide the service, but the government has appealed – and while the legal wrangling continues high-risk individuals cannot access Truvada. The trust said it hopes for a decision on the appeal this month.

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