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The High Authority for Health has just published new recommendations concerning PrEP, pre-exposure prophylaxis, against HIV. What’s new? Update with Professor Jean-Michel Molina, infectious disease specialist at Saint-Louis hospital and Lariboisière hospital in Paris.
On Wednesday, November 20, the High Authority for Health (HAS) unveiled new recommendations concerning pre-exposure prophylaxis (PrEP), the treatment taken to prevent HIV infection. She recommends expanding access to this preventive treatment.
An expansion to other categories of the population
Available in France since 2016, this treatment is mainly taken by men who have sex with other men. “98% of people who take pre-exposure prophylaxis (PrEP) are men. And it is estimated that since the beginning, 90,000 people have used it at least once and 50,000 regularly” confirms Professor Molina.
However, the recommendations must evolve according to the HAS, the National AIDS Research Agency – Emerging Infectious Diseases (ANRS-MIE), and the National AIDS Council (CNS). And according to their new findings, preventive treatment must be extended “to all situations considered to be at risk of exposure to HIV, regardless of the gender and sexual orientation of the person.
According to our expert, this is already the case. “The latest recommendations dating from 2021 already recommended the same thing and this is what we are doing, in practice. The other populations affected by the treatment are heterosexual migrant men and women, who come from elsewhere. Moreover, unlike France, on a global scale, it is mainly women who take PrEP.”
“About 20% of homosexuals do not protect themselves”
Other recommendations include European authorization for injectable PrEP, which dates from last year. “Injectable Cabotegravir-LP will make it possible to offer solutions in the event of a contraindication to PrEP by TDF/FTC, or when oral PrEP cannot be used under good conditions” can we read on the HAS website. For Jean-Michel Molina, it must be reserved for certain special cases, due to its cost. “It is preferable to focus on PrEP tablets, with a generic whose price remains accessible” estimates the infectious disease specialist.
For him, the real problem is the too large number of people who do not protect themselves from the disease. “It is estimated that 20% of homosexuals do not protect themselves from infection, either with PrEP or with condoms. However, the latest figures show thatHIV-AIDS epidemic is on the rise again and late screenings are still too numerous“.
The doctor links them to psychological brakes, essentially. “THE screening tests are free, but it is still difficult for some people to take the plunge and go, but it is the key to treating an infection as early as possible and avoiding further contamination“.
The new recommendations go in the same direction and wish “strengthen targeted and repeated prevention and screening actions in the most exposed populations, while continuing systematic screening in the general population”.
Inform the general public about PrEP, based on the contraceptive model
They also invite “after a sexual exposure accident”, to “a sequence between post-exposure treatment and pre-exposure preventive treatment”. But according to Jean-Michel Molina, pre-exposure prophylaxis is still poorly understood. “If you talk about PrEP in those around you, you will see that almost no one knows what it is”.
He believes that the general public should be informed of the existence of this treatment. “A bit like contraception: there is a pill that can prevent you from getting pregnant; there is also a tablet that can prevent you from contracting HIV” he concludes.
Screening for HIV in pharmacies, a first in France
In the Alpes-Maritimes, an experiment with “rapid HIV diagnostic orientation tests” has just been launched in six pharmacies in the department, all located in the Menton basin. Since last October, pharmacists have been responsible for carrying out these tests. They are done without a prescription, without upfront costs, with immediate results. Anonymity and confidentiality are also guaranteed.
“The project will initially be deployed on an experimental basis in certain areas of the Alpes-Maritimes, before a potential extension to other territories, less endowed with medical resources, depending on the results. This new lever for action will bring the region even closer to the ambitious goal of ending HIV transmission” explains a press release from the association “Objectif AIDS Zéro, Nice and the Alpes-Maritimes are committed!”, the CPTS of the French Riviera and the Regional Coordination Committee for the fight against HIV and STIs (COREVIH Paca- East).
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