PEP finding its target

Almost 10 percent of Sydney gay men reported having used PEP in the recently completed Health in Men study, but the cost could be unsustainable.

The four-week course in anti-HIV drugs was intended for accidental exposure and still carries severe side effects for many users.

The high usage was a surprise to Professor Andrew Grulich from the National Centre for HIV Epidemiology and Clinical Research, because until recently gay men around the world had little knowledge of PEP.

The anti-retroviral drugs are heavily subsidised by the Australian Government, but Grulich said PEP’s popularity was enough to raise questions about effectiveness.

“The person pays just the cost of prescription, around $20-$30, but the cost to the nation is $1,000-$1,500, so it’s a real concern,” Grulich said.

“If 10 percent of gay men around the country started using it, that would be a very large cost, and not sustainable.”

Yet it was worth the expense if the treatment was used appropriately, he said, as once-off protection rather than an alternative to condoms.

“Those who reported PEP use in the study also reported pretty high-risk exposure, so in Sydney at least its use is pretty well targeted,” Grulich said.

A spokeswoman for NSW Health said guidelines ensured people with repeated non-occupational exposure were counselled to address underlying issues.

But the study found gay men who took PEP exhibited the same level of risk taking after the course.

ACON community health director Nick Corrigan said gay men knew not to use it as a primary defence.

“Given that they’re recognising that a risk took place, and doing something about it, shows a certain amount of commitment to staying negative,” Corrigan said.

He said ACON supported the current guidelines and availability because it was going to people who would otherwise have become infected.

Gay men are the only group routinely offered PEP after reported unprotected sex or blood-to-blood contact. Heterosexuals, injecting drug users, and sexual assault victims are given the treatment only if the other party was known to be HIV-positive.

Grulich said there was still some debate regarding the use of the treatment for the insertive partner in anal sex.

“They often receive PEP but the overall risk is pretty low,” Grulich said. “The doctor makes an assessment on the likelihood that the partner is HIV-positive.”

The drugs are almost never offered after oral sex.

Grulich said the main problem with over-prescribing was cost, but an incomplete course by someone infected could cause resistance mutation causing problems with later treatments.

That threat remained theoretical because current treatments have proven to be almost 100 percent effective – there hasn’t been a single case in Australia where PEP has failed.

PEP is obtainable from sexual health clinics and emergency departments and must be taken within 72 hours of exposure to be effective. NSW Health runs a hotline for more information on 1800 PEP NOW (1800 737 669).