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Truvada in New Zealand

Wed 1 Jun 2016 In: HIV View at Wayback View at NDHA

Pre-Exposure Prophylaxis (PrEP) has been making inroads elsewhere in the western world. What is the New Zealand situation, however? The New Zealand AIDS Foundation has a PrEP webpage which explains the situation. PrEP insures that there is sufficient HIV medication in the human body to fight off HIV if there has been recent unsafe sex and possible HIV exposure as a consequence. The HIV medication used in this context is Truvada, which contains two antiviral medicines, Tenofovir and Emtricitabine. NZAF warns that PrEP is not one hundred percent effective, and that to have optimal protection, one must also still use condoms. It is dangerously simplistic to view this as an 'either/or' situation in which condoms can "now"be discarded. It must be taken daily to be effective- and even then, it is eighty six percent effective. Moreover, while it provides protection against HIV, it does not provide analogous protection against other sexually transmitted infections (STIs) such as Hepatitis C, syphilis, gonorrhea and LGV. All of these STIs are on the rise in New Zealand and may increase risk of ancillary HIV exposure. Truvada also has some side effects- weight loss, headaches, diarrhoea, nausea and fatigue. Moreover, there is an absence of research data related to long-term continuous use amongst HIV- people. PrEP should only be used under the supervision of a sexual health specialist, with joint treatment for HIV and STI tests, as well as minimising the onset of any unfortunate side-effects such as the above. If you contract HIV during this period, it may adversely affect the effectiveness of Emtricitabine, especially. As for the availability of Truvada in New Zealand and elsewhere, the situation is this. Truvada is available as Pre-Exposure Prophylaxis in Israel in the United States. It is also available through clinical trials. health insurance programmes and pilot studies in other countries. At present (June 2016), New Zealand pharmaceutical purchase regulatory agency Pharmac does not fund Truvada, which means that potential users must pay $NZ 1200, the full New Zealand retail price. Nor has New Zealand health product safety regulator MedSafe assessed Truvada for risk and safety. On May 6, Australia's Pharmac equivalent, the Therapeutic Goods Administration, funded Truvada for HIV prevention in that country, raising hopes something similar might occur in New Zealand. The NZ AIDS Foundation is lobbying for such an outcome. In the interim, it hopes to have a clinical trial available for high risk individuals at risk of HIV exposure after mid-2016. Canada did so earlier this year, in February 2016, although provincial health insurance pharmaceutical schedules have yet to indicate levels of funding or coverage. South Africa's Medicines Control Council provided a clean clinical bill of health in that country in December 2015. The National AIDS Trust and Terrence Higgins Trust are vigorously lobbying the Cameron administration to reverse the National Health Service England's decision to delay commissioning further use of the drug after the conclusion of Ipergay in France, one of two successful national clinical trials to assess the utility of the drug (the other is PROUD, in the United Kingdom). However, on May 31 2016, the UK National Health Service stated that it "does not have the power to commission PrEP/Truvada" in the United Kingdom. Originally, a decision on its availability there had been postponed until 2018 because it wanted data from 'further' clinical trials other than PROUD and Ipergay. Due to the aforementioned agitation from the National AIDS Trust and other British HIV/AIDS NGOs, NHS England's Specialised Services Commissioning Committee met in late May 2016 to reassess their decision. Unfortunately, the outcome wasn't what was hoped by the latter. The SSCC accepted NHS England's case that it was not free to commission Truvada's early release in the United Kingdom, but it would run and fund preliminary early clinical implementer trials to the sum of two million pounds. Gay Men Fighting AIDS, the Terrence Higgins Trust, the National AIDS Trust, and health spokespeople from Labour, the Conservatives and Liberal Democrats have all slammed the decision, arguing that it imposes economic apartheid on low-income HIV+ people who will be unable to afford the new treatment. NHS England's operational independence means that it is not bound to reflect contemporary government priorities and demands. For further information on the PROUD and Ipergay clinical trials, see the links from the UK National AIDS Trust below. Data from PROUD became available in September 2015, while Ipergay released its findings in December 2015. But how is New Zealand's Pharmac assessing Truvada? That will be the subject of a later column. Craig Young - 1st June 2016    

Credit: Craig Young

First published: Wednesday, 1st June 2016 - 10:45am

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