Kanikah Mehndiratta, MSc, University of Glasgow
Pre-exposure Prophylaxis (PrEP) is a national program by the US government that provides medication with anti-retroviral drugs. It is specifically intended for adults and adolescents that are at higher risk of getting infected with the Human Immuno Virus (HIV) in the future. It is a preventative approach in which if an individual gets exposed to the virus, the virus won’t be able to take hold and spread throughout the body. The official US HIV clinical information website, HIV.gov lists only 2 medications that are FDA approved as part of the PrEP. A recent forecasting study published in The Lancet presents PrEP trajectories based on user data in many countries that adopted the same WHO guidelines.
Why should one take PrEP?
A prophylactic approach has shown to be effective if medicines are consumed as per indication. A daily dose has been seen decreasing the risk of getting HIV through sex by 90% and through drug injections by 70%. PrEP is usually recommended for an HIV- negative individual that has a sexual partner with HIV, has had unprotected intercourse consistently or has been diagnosed with a sexually transmitted disease in the last 6 months. It is also suggested for those who inject drugs or who share syringes with a partner who injects drugs. Women trying to get pregnant with a partner who has HIV can also be prescribed such drugs in order to protect their unborn child from the viral infection. A person who has consumed multiple courses of post-exposure prophylaxis and is now reporting high-risk behaviour could also take PrEP. Two anti-HIV drugs, the Emtricitabine (F) and the tenofovir disoproxil fumarate (TDF) are combined in a single pill (F-TDF), also called Truvada.
Research Strategy
A global target of 3 million oral PrEP users by the end of 2020 was decided by the UN General Assembly 5 years ago. The study in discussion aimed towards analysing global trends in WHO recommended PrEP usage in order to predict the future course of the prophylactic approach for AIDS. Data was collected via the Global AIDS Monitoring System and the WHO regional departments. General trends between 2016-2019, including information on gender and priority populations, were considered for the study. User numbers were predicted by 2023 for selected countries that had presented at least 3 years of PrEP user data. Different possible scenarios such as COVID-19 associated disruption etc. were taken into account when predicting user growth rates in countries in the same region as the ones following WHO PrEP guidelines. Countries with no PrEP users yet but an adoption of PrEP guidelines were placed on step 0 of the PrEP trajectory while the rest were given step rank based on the number of continuous years of reported usage of PrEP.
Fig. Depiction of different regions of the world such as African, Eastern Mediterranean, European, American, South-East Asian, and Western Pacific that have been following WHO oral PrEP recommendations at a national scale (Image taken from Schaefer et al., 2021).
Significant Findings
About 67% of the total countries in consideration had adopted the PrEP approach at the national scale. About 40% of PrEP users were in American regions and about 30% belonged to the African region. Without disruption due to COVID-19, about 1 million users were predicted through the initial strategy by the end of the decade and about 5 million by 2023. If the disruption leads to no PrEP user growth in 2020, the projected numbers could reduce by at least 2 million. Overall, strong growth in PrEP usage is predicted in the upcoming years. Better research into newer PrEP medicines and a simplified delivery approach could help in eliminating AIDS from the world by 2030.
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References:
1. Schaefer, R., Schmidt, H.-M. A., Ravasi, G., Mozalevskis, A., Rewari, B. B., Lule, F., Yeboue, K., Brink, A., Mangadan Konath, N., Sharma, M., Seguy, N., Hermez, J., Alaama, A. S., Ishikawa, N., Dongmo Nguimfack, B., Low-Beer, D., Baggaley, R., & Dalal, S. (2021). Adoption of guidelines on and use of oral pre-exposure prophylaxis: A global summary and forecasting study. The Lancet HIV, S2352301821001272. https://doi.org/10.1016/S2352-3018(21)00127-2
2. May 20, Content Source: HIV govDate last updated: and 2021. “Pre-Exposure Prophylaxis.” HIV.Gov, 20 May 2021, https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis
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Author info:
Kanikah Mehndiratta is an avid researcher in the field of Genetics with a background in Biotechnology. She is a postgraduate from the University of Glasgow in their Medical Genetics and Genomics program. Currently, based in Chandigarh as a scientific writer, she involves herself mainly in projects related to neurological disorders. Outside of academics, she likes to read novels, travel and is involved in volunteer work mostly.
LinkedIn profile– https://www.linkedin.com/in/kanikah-mehndiratta-301830171
Other publications:
2. https://bioxone.in/news/worldnews/iga-virus-immune-complex-neutrophils-trap-for-sars-cov-
3. https://bioxone.in/news/worldnews/understanding-cancer-pathophysiology-via-isotopic-tracing/
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