Simon Collins, HIV i-Base
Compelling results on the real world efficacy of generic PrEP by gay men in London were presented in a poster by Issac Aloysius and colleagues from the 56 Dean Street clinic in Soho.
Since February 2016, this NHS clinic has been providing free routine HIV, STI and renal monitoring for people using generic PrEP that they buy online. More than 700 people have been using this service over the last year, and data was presented for 371. Median time since starting PrEP is 17.2 months.
Baseline characteristics include 99% men and 82% white, with median age 37 years (IQR 30 to 43). Overall, 90% were using daily PrEP and 10% using event-based dosing. Baseline eGFR was >60 in 96% of samples, with reduced renal function on PrEP only reported for 1 person who had pre-existing renal problems.
The TDM monitoring in the service confirmed all generic drugs were genuine. Overall, 97% were using Tenvir-EM from Cipla, with 88% of first TDM sample and all repeat samples showing comparable drug levels to branded formulations.
Most importantly, from 223 patient years of follow-up (data was included up until the last HIV negative test) there were no new HIV diagnoses (0%, 95%CI: 0 to 1.6%). This was despite participants having high likely exposure risk for HIV.
For example, 30% reported ChemSex while on PrEP (use of methamphetamine, mephedrone or GHB) and there were high rates of STIs during follow-up: 26% chlamydia (92/348), 23% gonorrhoea (79/348), 3% syphilis (11/348). However, there were no cases of HBV and only three cases of hepatitis C (1%), which given the cohort could easily have been higher.
The poster showed monthly HIV diagnoses at Dean Street falling from 71 in June 2015 to approximately 20 a month for the last six months to January 2017.
Aloysius I et al. InterPrEP (II): internet-based pre-exposure prophylaxis (PrEP) with generic tenofovir DF/emtricitabine (TDF/FTC) in London: analysis of safety and outcomes. British HIV Association Conference, abstract P32, Liverpool, April 2017.