Featured news from NHIVNA
HIV-related news from NAM
PrEP rollout recipients in France top 1000: full trial results report 97% effectiveness
Gus Cairns, 2016-07-29 09:10:00
Up to July 2016, 1077 people, 96.4% of them gay men,
have started HIV pre-exposure prophylaxis (PrEP) through the public healthcare
system in France, Jean-Michel Molina, principal investigator of the Ipergay
trial, told delegates at the 21st International AIDS Conference (AIDS 2016). Ninety clinics now offer PrEP assessment and prescription and
273 doctors have been accredited as PrEP physicians.
Half of PrEP recipients are in the Paris/Île de France
area while more than 10% each are in the Auvergne, Rhone/Alpes and Provence/Côte
d'Azur regions. However there is no region of mainland France that does not now
include some PrEP recipients.
approval by the European Medicines Agency on 22 July means that France can
now supply PrEP as a normal part of healthcare rather than via the emergency
Temporary Recommendation for Use (RTU) pathway.
Molina said that two-thirds of PrEP users in France had
opted to take PrEP intermittently in accordance with the regimen used in the
Ipergay trial; two pills in the 24 hours before sex and one each on the two
days afterwards, or daily if sex is continued. The other third opted to take it daily.
The average age of the PrEP recipients was 38, and all
but 3.6% of them were gay men. Of the nine people who were women, three of them
There have been two infections among the 1077
recipients. One of these tested positive at his one-month clinic visit and
turned out to have had acute HIV infection the day he started PrEP. He had
developed resistance to emtricitabine. The other was assessed for PrEP in
November but decided he could not afford the initial charges that are largely
recoupable through the healthcare system (see
this report). He decided instead to get what were, by his own account,
suboptimal doses of PrEP from friends. He tested HIV positive four months
At Molina's own clinic in Paris, where 396 people have
started PrEP up to 1 July, one in six people wanting it had already used 'informal
PrEP' and over half had used post-exposure prophylaxis (PEP). Molina said
that 39% had heard about PrEP from friends, 25% from the internet and 19% via
the helpline run by AIDES. Three (0.7%) tested HIV positive at baseline.
Twenty-two per cent were referred to psychiatric services – "This is a
vulnerable population," said Molina.
PrEP was proving challenging to implement, he said.
Doctors willing to prescribe PrEP had to agree to at least ten consultations
per week in addition to their existing workload, including 2 to 3 evening ones.
There was a need to train more sexual health nurses, not just for PrEP
assessment but to meet the increased need for STI treatment due to more
diagnoses. There was not enough patient-friendly PrEP guidance and more
resources were needed for the peer counselling offered by AIDES and for