Singapore

PrEP signals start of 'new phase of HIV prevention'

New drug to prevent HIV infection available at some clinics, hospitals here

A new drug shown to be effective in preventing infections of the human immunodeficiency (HIV) virus in high-risk groups is now more commonly available here.

It is known as a PrEP or pre-exposure prophylaxis.

It is expected to reduce the number of new infections here, now totalling about 450 a year.

"The question is how do we drive it down to zero," Mr Steve Kraus, director of the UNAIDS regional support team for Asia and the Pacific, told The Straits Times.

PrEP is available at the National University Hospital (NUH) at its Be Prepared Clinic and Tan Tock Seng Hospital, while the DSC Clinic in Kelantan Lane plans to offer it from the first quarter of next year.

Some studies have suggested that PrEP can be a useful supplementary option for those who are at high risk of HIV infection, said Senior Minister of State for Health Amy Khor, at the Singapore Aids Conference at NUH last Saturday.

This is an additional protection. We are not abandoning ABC (abstinence, being faithful and consistent condom use). Professor Roy Chan, founder and president of Action for Aids

NOT 100%

Dr Khor noted that PrEP is not 100 per cent effective and does not protect against other sexually-transmitted diseases.

Truvada, approved for PrEP use in 2012 by the US Food & Drug Administration, is also available elsewhere in Asia, including China, India, Thailand and Vietnam.

  • Total number of people in Singapore infected by HIV (as of October 2016)

  • People who have died of HIV in Singapore (as of end-2015)

Mr Kraus, who was the keynote speaker at the Aids conference, said: "We know that it works and it is a safe drug. It is unlike HIV treatment where, if you are HIV-positive, you need to take medication every day for the rest of your life."

Made up of two drugs used to treat HIV infection, Truvada is taken only when the user may be exposed to the virus.

Though it has been here since mid-2012, Truvada was reportedly offered only by a few clinics and given selectively, for instance, to the spouses and partners of infected people.

But that has changed.

Dr Dariusz P. Olszyna, a senior consultant at NUH's division of infectious diseases, said there is "overwhelming evidence and international guidelines which now recommend PrEP as an important tool in HIV prevention".

In San Francisco city, HIV infection rates have fallen as the number of PrEP prescriptions rose significantly, said Professor Roy Chan, founder and president of charity Action for Aids.

While the number of new HIV infections in Singapore has stabilised in the last five years, it has increased in some groups, such as gay men.

Latest figures from the Ministry of Health show that nearly four in 10 are at a late stage of infection by the time they are diagnosed.

If left untreated, HIV can lead to Aids (acquired immunodeficiency syndrome), where the immune system has been permanently wrecked, leaving the patient open to opportunistic and life-threatening infections.

With PrEP, said Prof Chan, "this is the start of a new phase of HIV prevention".

He added: "Even as I speak, there are studies going on in other places on impregnating PrEP into vaginal rings and on PrEP being given as a once-a-month injection and so on."

NOT REPLACEMENT

Prof Chan emphasised it is not meant to replace tried-and- tested methods of prevention.

"This is an additional protection. We are not abandoning ABC (abstinence, being faithful and consistent condom use)."

Nor does PrEP replace testing.

He said: "When people are on it, they need to keep in touch with healthcare.

"We advise testing every three months for sexually-transmitted diseases and HIV.

"If a person already has HIV but doesn't know it and he goes on PrEP, that's very dangerous."

The HIV infection may be inadequately treated and the virus could become resistant.

As PrEP is available only through prescription, those who ask for it will receive counselling as well.

At NUH, clients get a comprehensive assessment of their HIV risk and individualised advice on how PrEP can help them in reducing the risk, said Dr Olszyna.

The monitoring will continue for possible side effects and PrEP users will be tested regularly, as early detection and treatment of HIV offer a good chance of survival.

As of October this year, 7,459 people here were infected by HIV. Figures show that by the end of last year, 1,816 had died of it.

PrEP costs more than $400 a month and the length of time it needs to be taken varies from person to person, said Prof Chan. There is also the cost of tests and consultations.

"There's a newer approach where individuals take it a few hours before sex and then for two days after that. That's PrEP on demand and that's also a possible strategy," said Prof Chan.

"It's still early days. At this point, the challenge is to make PrEP more affordable."

What is PrEP?

What is PrEP and where to get it?

PrEP, short for pre-exposure prophylaxis, is a medicine that can reduce a person's chances of getting infected with HIV.

It works by stopping HIV from taking hold and spreading throughout the body.

PrEP is taken before a person's exposure to HIV and is meant to be an additional tool to reduce the risk of infection from the disease.

It is meant to supplement, not replace, condoms, an effective preventive method against HIV.

The pill is taken once a day. It contains two medicines - tenofovir and emtricitabine - that are also used to treat HIV.

What do the studies show?

PrEP has been shown to reduce the risk of HIV infection through sex for gay and bisexual men, transgender women, heterosexual men and women, as well as people who inject drugs.

It can cut the risk by more than 90 per cent.

PrEP does not work after you stop taking it.

Who is it for?

It is for HIV-negative people or those who do not have HIV infection, but who have a high risk of getting it. These include sexually active gay men and anyone in a relationship with a HIV-positive partner.

Are there any side effects?

Side effects are uncommon. Some people developed early side effects such as an upset stomach or loss of appetite, but these were mild and usually went away within a month.

Some people reported having mild headaches. But no serious side effects were observed.

Sources: Action for Aids Singapore, US-based prepfacts.org and Aids.gov


For help: 

Be Prepared Clinic NUH Medical Centre: 6772-8686 or send an e-mail to umcapptline@nuhs.edu.sg

TTSH: 6357-7000

DSC Clinic: 31, Kelantan Lane. Call 6293-9648 or send an e-mail to apptdsc@nsc.com.sg

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