The National Institute for Health and Care Excellence (NICE) has published a summary of evidence for the use of Truvada (emtricitabine and tenofovir disoproxil) as pre-exposure prophylaxis (PrEP) against HIV in adults at high risk of infection.
NICE, England’s health technology assessment body, found that Truvada is clinically effective in reducing HIV acquisition in high-risk people but also identified issues around treatment that need to be considered, such as uptake and adherence, sexual behaviour and drug resistance.
The evidence summary is not formal NICE guidance and does not make any recommendations. It also does not include a cost-effectiveness analysis.
“The cost-effectiveness of PrEP is likely to be dependent on variables such as HIV incidence, uptake, adherence, trends in condomless sex and drug costs,” says Gillian Leng, deputy chief executive of NICE. “This review has outlined a number of issues that will need to be taken into account.”
In the trials reviewed as part of the evidence summary, Truvada reduced the relative risk of acquiring HIV infection by between 44% and 86% compared with placebo or no prophylaxis, says NICE.
The provision of PrEP may increase access to other health services, such as HIV testing, sexually transmitted infection and hepatitis B screening and support for high-risk sexual behaviour, the evidence summary concludes.
NICE was asked by health secretary Jeremy Hunt to review the evidence for Truvada used as PrEP against HIV in June 2016. The drug was approved for use as PrEP by the European Medicines Agency in August 2016.