Groups at higher risk of HIV disease should have access to a class of anti-retroviral drugs before and after exposure to the virus, according to new federal guidelines aimed at controlling the spread of this disease in Canada.

The guidelines, being published Monday in the CMAJ medical journal, are for health professionals working with individuals at risk of getting the disease through sex or injection drug use. They recommend physicians prescribe pre-exposure prophylaxis (), a class of anti-HIV drugs that starts prior to an exposure to the virus occurs, and nonoccupational postexposure prophylaxis (nPEP), which entails taking anti-retroviral drugs following a sexual or drug use-related vulnerability to HIV.

“There are a whole lot of individuals who may benefit from [PrEP and nPEP] across the nation, and not nearly enough suppliers who can provide it to them,” said lead author Dr. Darrell Tan, an infectious diseases physician and researcher at St. Michael’s Hospital in Toronto. The guidelines were developed by the CIHR Canadian HIV Trials Network using a board of 24 experts.

“Since PrEP is so helpful in treating HIV, the objective is that by increasing uptake, we can actually move Canada towards a decline in the rate of HIV infections each year and move towards the eventual elimination of new infections.”

The authors said that the guidelines bring Canada up to speed with nations such as Australia, Britain and the USA, which already have similar national guidelines on HIV prevention and treatment.

Dr. Tan said the expectation is that the guidelines can better equip general practitioners to prescribe PrEP, because not all front-line employees are knowledgeable about HIV therapy.

Ryan Lisk, director of community health in the AIDS Committee of Toronto, says that a lack of guidelines previously supposed that patients experienced inconsistencies when seeing physicians for treatment.

“It has always been a bit of a lottery if you receive a doctor with the assurance to prescribe the medicine in the ideal way,” stated Mr. Lisk, who had been involved in the consultation process for the guidelines.

“These guidelines help to standardize access throughout the nation, so that doctors and general practitioners can prescribe PrEP and nPEP with confidence.”

The new guidelines are also more feasible this year, largely due to an expired patent that reduced drug prices. Also, Ontario started covering a part of the purchase price. Treatment formerly cost around $1,000 per month in Ontario, but that price was reduced to approximately $250 for individuals without insurance in September. Some men and women that are covered by private or universal insurance would pay even less. Dr. Tan said that Quebec also subsidizes the drug, but states that it is troubling that the rest of the country does not.

“It is a travesty that [money] should be a barrier to people accessing something which could protect against HIV infection,” said Dr. Tan, who pointed out that it’s cheaper for governments to finance the prevention of HIV than to deal with those who have contracted the illness.

The authors said the guidelines might be of special importance for caregivers working with populations that are disproportionately affected by the disease. Over half of new infections (54.3 percent) occur in homosexual, bisexual and other men who have sex with men, according to the report writers. HIV incidence among people who inject drugs, individuals from HIV-endemic nations, and Native people is estimated to be 59, 6.4 and 2.7 times greater than other Canadians.

Dr. Tan noted that there’s still some stigma associated with the treatment, particularly beyond the homosexual, bisexual and queer community in which folks are not as aware of the medication. However, Dr. Tan notes that there was stigma around the birth-control pill when it first introduced, and he expects that PrEP can one day be routinely accepted as the pill.

“In many senses, birth control represents a kind of empowerment to take control and responsibility of one’s own health and future, in ways we look on as really ordinary,” said Dr. Tan. “We look forward to a day where that is a reality for PrEP.”

Courtesy: The Globe And Mail

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