Australia’s biggest study on the use of HIV prevention treatment begins

IF massively reducing your chances of contracting a chronic virus was as simple as regularly popping a pill, would you take your daily dose?

That’s the question researchers from the University of NSW’s Kirby Institute will be asking 300 HIV-negative men over the next two years.

The PrELUDE study will be the largest of its kind ever conducted in Australia to test the real-life experiences of people taking a two-drug combination therapy, currently used to treat HIV, as a pre-exposure prophylaxis (PrEP) to prevent transmission.

The World Health Organisation estimates that widespread PrEP use could reduce the risk of HIV transmission in people who take part in risky behaviours by up to 92 per cent and could decrease transmission rates in gay men by 25 per cent, averting one million new diagnoses.

Australia has a target of eliminating the transmission of HIV by 2020.

Chief investigator of the study, Dr Iryna Zablotska-Manos, said while research overseas had already proved PrEP’s effectiveness, “whether PrEP confers high rates of protection in real-life situations and is a feasible strategy to implement still requires further investigation, and that is what we are seeking to do through PrELUDE”.

In particular, there are question marks about the willingness of people who are HIV-negative to remain committed to taking the drugs every day over long periods of time.

Zablotska-Manos said a strong focus would be on men having regular casual sex including those who have made the decision not to use condoms.

“This prevention strategy is for people at high risk for HIV infection so someone who only has a very brief period of risk is probably not the best candidate,” she said.

A recent French study found HIV-negative men taking PrEP only intermittently, before and after risky sexual encounters, still proved to be an effective strategy for minimising infection.

However, Zablotska-Manos said the European study had not yet concluded and the PrELUDE research would ask people to take PrEP on a daily basis — although this could change if more data around “on demand” PrEP became available.

While not currently licensed as preventative medication in Australia, the NSW Government has committed to looking at how to best implement PrEP, with the current study a likely step on the way to its eventual introduction.

Positive Life NSW chief executive Craig Cooper congratulated the Kirby Institute and NSW Health for progressing with the study.

“Every HIV diagnosis is one too many and PrELUDE will assist in achieving an end to HIV transmission,” he said.

ACON chief executive Nicolas Parkhill said his organisation “strongly believes that gay men should have access to the full range of proven prevention technologies, and the early indications are that PrEP offers a major risk reduction strategy for individuals at high risk of HIV”.

The study will be funded by NSW Health and Gilead Sciences, the US makers of HIV drug Truvada which will be given to PrELUDE participants.

Interim results from the study are expected late next year with full findings in 2016.