#AskDocQ: Is PrEP Driving Up The Rate Of STIs?


Last time, the Doc reported some major research findings presented at the recent HIV conference she attended in Boston.  This time, Brisbane LGBTIQ health specialist Dr Fiona Bisshop concludes her round up of some of the key topics.

Vaccine Progress

There is no doubt that a vaccine is essential if we are ever going to end the HIV pandemic. However HIV presents unique challenges to vaccine scientists.
A vaccine needs to be more than 50% protective to be of any public health benefit.

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Only four HIV vaccines have ever made it to clinical trials, and only one showed any clinical benefit, and this showed only 30% protection.

Now a new vaccine is entering phase 2b clinical trials after showing a 100% antibody response in recipients. The trial is enrolling women in Africa and is called Imbokodo, which means rock in Zulu, referring to the strength of women. Findings are due in three to four years, and I am truly excited about this one!

PrEP

These days PrEP is getting almost as much attention as treatment at HIV conferences, and with good reason. It works! The introduction of PrEP in cities such as San Francisco and Sydney has led to a striking drop of up to 35% in new diagnoses.

What about the PrEP failures?  Well, despite the many thousands of people on PrEP all over the world, there have only been four reported cases of PrEP failure, and in at least two of these the cause was resistant virus, i.e. these unlucky individuals were infected with a virus which was already resistant to the drugs in PrEP.

The likelihood of this occurring is very low, as resistant virus is rare in the community.

Future PrEP possibilities include implants containing tenofovir alafenamide (TAF) or MK8591 (the new treatment drug reported last issue), and maybe a weekly pill.

Is PrEP driving up the rate of STIs? It’s not as simple as that. People are being tested more often and at more bodily sites, and there is increased availability of rapid tests.

Condomless sex is certainly increasing, but the increase in STIs started well before the widespread availability of PrEP, in fact pretty much since the advent of smart phones! Should we blame meet-up apps?

The take home messages about PrEP for me were:

  • PrEP is not a medical intervention, it’s a lifestyle choice.
  • PrEP is affordable when the alternative is getting HIV.

HIV and Heart Disease

We know that HIV infection raises the risk of heart disease, but what can we do about it? The most effective interventions are:

  • Stopping smoking
  • Treating high blood pressure
  • Lowering cholesterol with statins
  • Considering switching off abacavir due to its effects on platelets
  • HIV and Cancer

There was some very interesting data presented on rates of cancers in statin users, based on an analysis of the US Veterans Aging Cohort Study.

People on statins have overall 40% reduction in cancers, and the benefit increased to 49% in HIV + people. Non-Hodgkin’s lymphoma dropped by 71%, oral cancer by 65%, lung cancer by 51% and anal cancer by 38%, and all cause mortality dropped by 45%.  This is pretty exciting stuff!

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Dr Fiona Bisshop specialises in LGBT health and is available by appointment at Holdsworth House Medical Brisbane. Call (07) 3894 0794 or visit the Holdsworth House website. For more details about any of these topics, visit Dr Fiona Bisshop’s website here or contact her on Twitter.

Do you have a health question for the Doc? Send it to doctorqnews@gmail.com and Dr Fiona Bisshop will answer them in each issue. #AskDocQ is completely anonymous. No identifying information will be printed in the Doc’s reply, and your personal information stays with the Doc.