NHS England will make PrEP available next year
NHS England and Public Health England have given an outline of a large study of the best way for the NHS to implement pre-exposure prophylaxis (PrEP), which is due to start in the middle of next year. This follows the Court of Appeal’s ruling last month that NHS England, alongside local authorities, has the power, but not the obligation, to fund PrEP and should plan how to provide it.
While many activists would have preferred the NHS to announce an immediate roll-out of PrEP to all who need it, there was also the risk that the NHS would have decided that PrEP was too expensive to provide at the moment.
The study may allow a significant number of people to get access to PrEP – around 10,000 people may take part over a three-year period. A large trial may be possible because NHS England and Public Health England are trying to drive the price of PrEP drugs down by pitting generic companies and Gilead (the pharmaceutical company that produces Truvada) against each other in a bidding war.
We know that the study will not be directed exclusively at gay men or any other population, but very few details of the trial have been settled. It is not clear whether the trial will be run at sexual health clinics across England, or only in a few selected locations.
Deborah Gold of the National AIDS Trust, which took NHS England to court, said that the trial would not be happening without the legal challenge, a series of parliamentary questions and strong community pressure for PrEP. “We are absolutely delighted that following our wins in Court, NHS England, working with Public Health England and local government will be now making PrEP available on a large scale, and quickly, to those who need it,” she said.
Greg Owen of iwantPrEPnow welcomed the announcement but said that the plans are not a permanent solution to wider PrEP provision. He called on NHS England to ensure that the limited availability of PrEP is targeted so it does not worsen existing health inequalities.
For more information on PrEP, read NAM’s factsheets ‘Pre-exposure prophylaxis (PrEP)’ and ‘How to get PrEP in the UK’.
Real-world data on hepatitis C treatment for people living with HIV
More than 90% of HIV-positive people treated with direct-acting antivirals for hepatitis C were cured of hepatitis C and few stopped treatment due to side-effects, showing that real-world clinical practice can produce results as good as those seen in formal clinical trials, according to Spanish data.
People who take part in clinical trials are not always typical of other patients, and they also get extra monitoring and support. For that reason, there is a possibility that results in clinical trials will be better than in routine medical care.
But these data provide reassurance on that point. They show that people living with HIV can have excellent results with modern hepatitis C drugs.
In Madrid, doctors are obliged to record details of all patients who have HIV and hepatitis C co-infection. The analysis therefore includes all 2300 people in Madrid who started hepatitis C treatment over an 18-month period. Most were men and their average age was 50. Importantly, just under half had cirrhosis, indicating significant damage to the liver.
The drugs most commonly used were:
- Sofosbuvir and ledipasvir (Harvoni combined tablet)
- Sofosbuvir (Sovaldi) and daclatasvir (Daklinza)
- the paritaprevir-based '3D' regimen (Viekirax + Exviera).
Overall, 92% of people had a continued undetectable hepatitis C viral load 12 weeks after completing treatment (i.e. sustained virological response or SVR12). This outcome suggests that the person has been cured of hepatitis C. Cure rates were similar between people with genotypes 1a, 1b, 3 and 4.
People with compensated cirrhosis (the earlier stage of cirrhosis, during which the liver is damaged but still able to perform most of its functions) had cure rates almost as good as those without cirrhosis. However, in people with decompensated cirrhosis (the later stage), cure rates were lower at 81%.
Less than 1% of people stopped treatment because of side-effects.
The results confirm that treatment outcomes are similar for people with co-infection and for people with hepatitis C alone.
For more information on this topic, read NAM’s booklet ‘HIV & hepatitis’.
Editors' picks from other sources
Top 10 HIV clinical developments of 2016
from The Body Pro
In typical years, a noteworthy development in the world of HIV would be the result of a landmark clinical trial or perhaps a gem of a lab study with a novel finding. But, 2016 was not typical. What made the most difference for people living with HIV and their health care providers this past year was less a paper published or presented than major shifts in our thinking about how best to prevent and manage HIV infection.
Three out of four providers offer HIV life assurance
from Financial Adviser
The latest survey by Unusual Risks, the medical financial advisers, showed 75% of insurers are now offering some form of HIV life assurance.
National AIDS Trust sets out vision for HIV in the future NHS
from National AIDS Trust
On World AIDS Day (1 December) the National AIDS Trust (NAT) is releasing a call-to-action on how the needs of people living with HIV should be met by the changing NHS in England.
Trump leaves AIDS advocates feeling anxious
from Bay Area Reporter
The election of Donald Trump has left many people with HIV, their medical providers, and advocates feeling uncertain and anxious. Although Trump said little about HIV during the presidential campaign, his opposition to the Affordable Care Act and his conservative Cabinet picks suggest many of the advances of the Obama years may be rolled back. But all agreed that it is hard to predict specific details.
Hepatitis C sheds enough in the rectum to transmit through anal sex
from Poz
Researchers have come up with the first direct evidence that enough hepatitis C virus (HCV) sheds into the rectums of HIV-positive men who have sex with men (MSM) to transmit directly to another man’s penis during anal sex, even when no blood is present.