The Round table meeting made some interesting points concerning the recent instigation of PrEP in the UK and France.
Jean-Michel Molina (Professor of Infectious Diseases at the University of Paris Diderot, France) showed that daily and on demand PrEP is cost effective for the community. More importantly it has helped take the fear of sexual activity and anxiety from a population that are over represented when it comes to mental health care issues. He felt that PrEP is still not reaching high risk groups such as young MSM, migrants and the trans population. Young MSM are a particular problem in that they often feel stigmatized about their sexuality and unwilling to engage with the medical profession. They may also be in some denial about their HIV risks and are a difficult population to ensure compliance with medication. Social media apps eg Grindr, Hornet and Planet Romeo are very important resources for HIV ,PrEP and PEP education.
PROUD and IPERGAY studies have confirmed the effectiveness of daily and intermittent/ on demand Truvada.(4 tabs). Maraviroc was not shown to be an effective PrEP agent. Current studies with TAF/FTC are promising as is injectable Cabotegravir LA. Topical drugs such as vaginal gels also have an important place. The possibility of future over the counter PrEP raised some concern by the panel who felt medical intervention is needed at some point in the PrEP pathway.
Emma Devitt from the Dean Street Clinic Soho, UK showed some impressive rates of decline in new HIV diagnoses in the last year. She felt this was due to a combination of factors their clinic offers including:
-frequent screening for HIV
-rapid ART instigation for HIV positive people
-regular STI screening and rapid Rx of STI
-use of PEP and now PrEP
A very informative and topical meeting from some incredibly dedicated and progressive doctors.