by Jonathan Learmont
Cardiff University’s Infections, Inflammation and Immunity Division will conduct world leading research on a new global HIV prevention strategy. It will be led by Deputy Director of the division, Dr David Gillespie after winning a Health Research Fellowship funded by the Welsh Government.
Pre-Exposure Prophylaxis (PrEP) is a prevention strategy where antiretroviral drugs (ARVs), often used in treating those tested HIV positive, are prescribed for HIV negative people to significantly reduce the likelihood of those at higher risk from being infected. When taken in a daily dose, the levels of ARVs are sufficiently high in the blood to prevent HIV from entering cells and replicating so the person exposed remains HIV negative. The study will examine numerous variables expected to influence the success of the strategy including treatment start, dosage and duration of medication. Currently, when looked at alongside patients’ sexual behaviours their effect is not well established.
“While the PrEP drugs are proven to reduce the chance of HIV-acquisition by up to 86%, there has been very little evaluation of how these drugs are being used in conjunction with sexual behaviour over time, and whether their use can be improved to increase their efficacy further,” Dr Gillespie said.
An average of 153 new HIV cases, the vast majority from sexual transmission, have been diagnosed annually over the previous six years in Wales. PrEP became available across Wales as part of a three-year trial in 2017 with approval from Vaughan Gething, Cabinet Secretary of Health, Well-being and Sport. NHS services in Wales have been able to prescribe the generic preparations of the drug used for PrEP since the summer of this year. Branded as ‘Teva’, it is now available from multiple sexual health clinics across Wales.
The reduction in spread of HIV internationally from PrEP would be most impactful in nations with young populations who may be unaware of their infection risk. One in five people worldwide with newly acquired HIV reside in South Africa. As of late 2017 an estimated 1,745 new infections occur weekly amongst women between the ages of 15 and 24, a demographic which makes up 10% of their population and is statistically the most susceptible in the country. Yet clinical trials carried out in South Africa such as FEM-PrEP struggled to ensure adherence to prescriptions, partly because patients underestimated their own risk.
Commenting on the potential outcomes of the investigation, Dr Gillespie stated “our new research uniquely centres on developing guidance that aims to optimise the use of PrEP”. This study can be significant in reducing infection figures both in Wales and globally, as available funding for tackling HIV could be used for PrEP in the most effective way. Its guidance may lay out the road map to fully address one of the biggest public health issues in the world today.