New cases of HIV are at the lowest rate since 1985, according to new research into outcomes of the New South Wales PrEP trial from the Kirby Institute.
Recent new transmissions have declined by nearly a third as a result of the UNSW-led PrEP (pre-exposure prophylaxis) trial, EPICNSW.
The results, released today in medical journal The Lancet, stem from research funded by NSW Health around the PrEP trial, which launched in March 2016.
It is the first study in the world to measure the impact of PrEP on HIV reduction in a large population
“The speed of the decline we’ve seen in new HIV infections in gay and bisexual men is a world first,” said Kirby Instutute and study lead Professor Andrew Grulich.
“In the year following the trial, state-wide new HIV infections in this population decreased by one third, from 149 infections in the 12 months prior, to 102 in the 12 months after.
“These numbers are the lowest on record since HIV surveillance began in 1985.
“Our research tells us these reductions are a result of PrEP, implemented on a background of high and increasing HIV testing and treatment rates.”
Rates of decline in new cases were the highest among Australian-born gay and bisexual men, at 48.7 per cent, and gay and bi men living in areas recognised as the ‘gay suburbs’ of Sydney, at 51.8 per cent.
“These communities had the highest uptake of PrEP, and, in these populations, new HIV infections have halved since the trial began,” Grulich said.
“However, we did not see the same reductions across the board.
“Reductions were lower in non-English speaking immigrants with a smaller 21% decline among those born in Asia.
“We need to improve education and promote access to PrEP, particularly amongst culturally and linguistically diverse men who have sex with men, and those outside the gay neighbourhoods of Sydney.”
NSW was the first state in Australia to trial PrEP at a large scale, enrolling 9,714 HIV negative people at high risk of HIV and providing them with PrEP.
Enrolments in the study ceased on April 30 this year when PrEP was made available through the Pharmaceutical Benefits Scheme (PBS).
“Now that PrEP has been listed on the PBS, and is available across Australia, we need to focus our attention on ensuring equitable access for all people at risk of HIV,” said Professor Grulich.
Two men in the PrEP trial became HIV-positive while they were enrolled, however both had been non-adherent.
“The results from EPIC-NSW provide an important evidence-base to inform our response to HIV globally,” added Grulich.
“We now know that PrEP implemented quickly, at a large scale, and targeted to high-risk populations can help turn the HIV epidemic around.”
Recent research has also found that people living with HIV are adhering to anti-retroviral treatments – known as treatment as prevention (TasP) – and therefore attaining an undetectable viral load at record levels.
HIV transmission rates in Victoria have also significantly declined, with the state recording a 22 per cent drop this year.
As Grulich noted, declines among men who have sex with men (MSM) born overseas are not seeing the same impact of PrEP, with new diagnoses among MSM born in Asia having risen to 58 per cent of cases among men born overseas and pointing to an overall rise in HIV rates in marginal communities.
A paper published in June noted that while rising PrEP has coincided with a decline in condom use, the incidence of other STIs remained roughly the same.