What’s New With PrEP?

Gay couple

What if there was a pill you could take daily to reduce your risk of getting HIV, but due to government regulations, it couldn’t be accessed in Australia?
You might think, “WTF?!” You might question why this was the case. You might think there was a good reason for this. Perhaps you might simply wonder how long it would take until this pill was made available.

For those who haven’t heard, this pill exists and is called PrEP (Pre-Exposure Prophylaxis). PrEP is a type of medication called Truvada that is already used in Australia to treat HIV.

The issue is, the Therapeutic Goods Association (TGA) that controls what we as Australians can or cannot use as “medicine”, has only approved Truvada to be used to treat HIV, not prevent it.

There has been plenty of research done overseas and in Australia to test if PrEP actually works. America has approved its use and the Communicable Disease Control (CDC) recommended its use for gay (and other homosexually active) men.

So, why is Australia behind the times?

Well, it comes down to time and money: a TGA submission costs too much for any single organisation; and Gilead Pharmaceuticals, the company that owns a patent on Truvada, has only just clarified that they are willing to provide support for it.

While the WA AIDS Council (WAAC) has released a position statement on PrEP which is largely supportive of the idea, the Council is not taking the important steps to see PrEP become available in Western Australia.

M Clinic encourages WAAC to stand by its commitments to the Melbourne Declaration which directly refers to establishing demonstration trials that provide access to PrEP, fast-tracking TGA approval and offering Pharmaceutical Benefits Scheme (PBS) funding of PrEP for high risk groups.

In the absence of readily available Truvada for PrEP in Western Australia, some are choosing to purchase it from overseas. This is possible with a prescription provided by a doctor where they request the drug “off-label” i.e. for a use that the TGA doesn’t currently approve it for.

The Australasian Society for HIV Medicine (ASHM), AIDS Council of NSW (ACON) and Positive Life NSW have released information sheets on how to access PrEP in Australia from overseas suppliers. M Clinic is thrilled about this development, however these documents don’t list WA specific referrals for accessing PrEP.

This is a concern as some may go to their local doctor and be refused PrEP due to lack of awareness by the practitioner, or worse, be prescribed for PrEP without HIV testing and counselling on adherence, precautions and monitoring.

Adherence i.e. how often the medication is taken, is a massive factor in how effective the pill is. Current recommendations suggest daily dosing is required – any less and you may not be as protected as you think you are. Tenofivor, one of the drugs used in Truvada, is linked to a number of common side effects (vomiting, diarrhoea) and in rare cases acute kidney damage.

Getting a prescription from a doctor that is knowledgeable about PrEP is paramount in ensuring you are provided with the right precautions, maintain a steady supply of Truvada and undergo important monitoring for kidney dysfunction.

If you are HIV positive without knowing, and were to commence PrEP assuming you were negative, you run the risk of developing resistance to drugs used in Truvada which could limit your HIV treatment options. This is why HIV testing prior to commencing PrEP is so important.

Condoms are still a big part of preventing HIV infection, as well as other sexually transmissible infections (STI) such as Gonorrhoea and Syphilis which PrEP doesn’t protect you against. However, we continue to see new HIV notifications despite condoms being readily available. What does this tell us? There are barriers to condom use for those who don’t use them routinely and they should have the option to access PrEP because we know it can reduce transmission.

PrEP is not for everyone. It currently involves a serious commitment to taking the medication on a daily basis with the risk of developing side effects. However, for those who feel they need it, or want to explore it as an option, information should be readily available.

Watch this space…M Clinic is developing its own WA specific fact sheets on PrEP which should be released in the next few weeks. In the meantime, join the conversation and tell us what you think. For more information visit www.endinghiv.org.au or contact the M Clinic via www.mclinic.org

Justin Manuel
M Clinic Coordinator

Image: iStock

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