One more reason to be PrEPed: it’s safe!

A report on Victoria Pilkington's "Meta-analysis of the risk of Grade 3/4 or serious adverse events in 12 randomised trials of PrEP (n=15,678)"

Since its presention at HIV Glasgow, there has been a lot of coverage of the meta-analysis of PrEP presented by Dr Victoria Pilkington of Imperial College, London (e.g. ow.ly/ALap30mppiv). The story has been re-told through a variety of medical and non-medical media emphasising the bottom line: TDF/FTC as PrEP is safe. As we know, there are an increasing number of PrEP prescriptions in North America, Australia, and Western Europe with the global estimated number of people taking PrEP to be around 300 000.

During the presentation, Dr Pilkington described the findings: no difference in safety between daily/intermittent PrEP, males/females, or number of risk events, including bone fractures. The only noted difference to the control was a low-grade elevation in creatinine for some participants, amounting to a grade 1/2 adverse event. For creatinine rise in the grade 3/4 category, there was no difference to the control.

What does this mean for us in Australia where PrEP is available and uptake continues to be on the rise? Locally, with the confidence we are doing no harm, we can work with people at risk to develop an individualised PrEP strategy as well as encourage our colleagues to do the same. Moreover, nationally and globally we can arm ourselves with studies like this to advocate for more cost-effective ways to deliver PrEP to at-risk populations.

The lingering question is that if TDF is safe for use in PrEP, is there an imperative to halt the push for PrEP with TAF (or other drugs) in the interest of cost-saving? I think that like ART, having a menu of options allows us to cater to individual health needs, however, putting our efforts behind TDF will mean that we can focus on getting PrEP to everyone who needs it thereby increasing the reach of this amazing tablet.

Author bio: Ian is currently a PHO (Registrar) at Cairns Sexual Health Service and a GP Registrar. He has a keen interest in holistic health including the implementation of change on the system level. Ian has a background in education, public health, and leadership having completed a Master of Public Policy at Simon Fraser University and courses in Medical Leadership at UQ. His interests expand to global health and health equity and consequently has been involved in health projects overseas.