Increased application of pre-exposure prophylaxis to prevent HIV transmission in men who have sex with men could eliminate HIV in this population in the Netherlands in the long term.

This conclusion was drawn this week based on a mathematical modeling study headed by Dutch researchers in the scientific journal AIDS.

Pre-exposure prophylaxis (PrEP) is a promising intervention that could end the Dutch HIV epidemic among men who have sex with men. In a recent study financed by the Dutch AIDS fund, Dr Ganna Rozhnova of the Julius Center for Health Sciences and Primary Care of UMC Utrecht assessed the impact of PrEP on HIV prevalence in MSM and determined the levels of PrEP coverage required to ultimately eliminate HIV.

Mathematical model

Ganna Rozhnova explains her study: "We have developed a mathematical model for the transmission of HIV through unprotected sex in an MSM population. We divided them into groups based on the number of sexual partners and incorporated universal antiretroviral treatment (ART) and daily PrEP use, depending on an individual's sexual risk behavior. The model allowed us to predict the future HIV prevalence, HRT and PrEP coverage for increasing PrEP and ART uptake levels and to study how these are impacted by PrEP effectiveness and the duration of PrEP use."

HIV elimination

The model showed that at the current level of ART coverage of 80 percent, a PrEP effectiveness of 86 percent and an average duration of PrEP use of 5 years, a PrEP coverage of 82 percent will be required in the group running the highest risk (12,000 men with more than 18 sexual partners a year). Definitive elimination of HIV will take a long time, but the incidence and prevalence of HIV were estimated to decrease by approximately fifty percent in about 15 and 40 years, respectively, after the start of the PrEP intervention.

Rozhnova about the practical significance of this study: "We believe that our study is a timely contribution that helps schedule PrEP application in the Netherlands and eliminate HIV in MSM over the next decades."

About PrEP

PrEP is a prophylactic HIV medicine that has to be taken daily by a person who is not infected yet and does not have unprotected sex. The medicine, which prevents HIV from replicating in the immune cells, consists of a combination of two virus inhibitors that together prevent development of HIV. PrEP may considerably decrease HIV infection in MSM, although it does not offer full protection. Every year, some 800 patients are newly diagnosed with HIV. Health insurers do not cover the costs of PrEP yet (€50 a month), as a result of which use is stagnating to approximately 10 percent of the MSM with the highest risk. However, PrEP will be included in basic healthcare in the Netherlands in the near future, which is expected to considerably increase uptake.

Publication

Rozhnova G, Heijne J, Bezemer D, van Sighem A, Presanis A, De Angelis D, Kretzschmar M. Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of pre-exposure prophylaxis. AIDS 2018;32:2615-2623