Drug watchdog ‘confirms case’ for HIV-preventing drugs on the NHS

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The UK’s drug watchdog NICE has today released a review of HIV-preventing drugs amid a legal battle on the issue.

Pre-exposure Prophylaxis (PrEP) drug Truvada can reduce the risk of being infected with HIV by up to 86% if taken daily, and has been endorsed by the World Health Organisation and Centers for Disease Control and Prevention for at-risk men who have sex with men (MSM).

This year NHS England has taken to the courts to argue that it is not responsible for commissioning the drugs, in a contentious legal battle with HIV activists

The body came under renewed pressure to act this month, after data showed HIV infections among MSM remain at record high levels.

Today, a report from drug watchdog NICE emphasises the benefits of PrEP in HIV prevention.

The NICE report, which contains only guidance and does not recommend a decision, emphasised the number of studies that have proven the effectiveness of PrEP, affirming: “There is little doubt that Truvada is effective in reducing HIV acquisition in high-risk people who are HIV-negative.”

It also noted existing cost projection models that have broadly shown PrEP to be a cost-effective treatment, if “very sensitive to key variables”, and noted guidance suggesting “giving priority for the use of PrEP to the people most at risk of acquiring HIV infection could increase its impact”.

Health experts say rolling out PrEP in the UK would be massively cost-effective if it leads to even a small reduction in HIV infections, as the lifetime cost of just one HIV infection can be up to £380,000. Preventing just 100 infections each year could offset the long-term cost of a PrEP scheme.

Activists have welcomed the report, which they say confirms the case for the NHS to commission PrEP.

Ian Green, Chief Executive of Terrence Higgins Trust, said: “Today’s NICE review points to substantial evidence for the effectiveness of PrEP when targeted at those most at risk of HIV.

“All of the evidence in the review corresponds with our own view that PrEP must be used as part of an overall prevention strategy, which also includes condom use, treatment and regular testing. We believe that PrEP could be the final, vital piece of this jigsaw in helping us end HIV transmission.

“In particular we are pleased that the review recognises the reassuring evidence that PrEP does not lead to more high risk sexual behaviour – and to WHO’s guidelines which state PrEP may improve opportunities for people to access other services such as HIV testing, STI screening and counselling.

“We now await the result of NHS England’s appeal, after a High Court decided it did have the legal power to commission PrEP. We hope this evidence review removes another barrier to PrEP being made available in the UK.

“Every day NHS England delays access to PrEP, 17 people are diagnosed with HIV – and the lifetime cost to the NHS for each diagnosis of HIV is £360,000. We cannot afford not to provide PrEP to those at risk.”

England’s Chief Medical Officer Dame Sally Davies recently called for PrEP to be made available.

The medicine chief said: “Whatever one thinks about it morally or anything, I can tell you it is a cost-effective public health intervention, so I do believe our system should fund it.

“You save infections and therefore money, and it has been thoroughly checked.

“The issue is whether it should be funded, and I think you have to separate the cost-effectiveness from whatever you think as a person.”