Anti-HIV drug and personal responsibility

 

Sir, – As someone who has been involved in the management of people living with HIV for nearly 20 years and the director of an Irish-based research programme recognised internationally for its research into drug safety of antiretrovirals used to treat HIV infection, I was bitterly disappointed to read the recent piece by Derek Byrne (“Anti-HIV drug removes personal responsibility”, Opinion & Analysis, April 20th).

Management of HIV infection has progressed considerably and the vast majority of people living with HIV in Ireland now access safe and effective treatment that has resulted in many now realising the opportunity to lead healthy lives.

To describe modern antiretroviral therapy as “highly toxic” is an irresponsible misrepresentation of facts that could raise unnecessary concerns for those thousands of people in Ireland currently living with HIV.

The drug referred to within the article (Truvada) has formed the backbone of effective therapy for those with HIV for more than a decade and, contrary to what the article suggests, has not been identified as a cause of abnormalities in fat distribution.

Derek Byrne asserts that use of Truvada for pre-exposure prophylaxis (PrEP) could be responsible for “widespread liver disease among gay populations in 10 to 15 years”. That statement is simply not supported by any evidence; in fact one component of Truvada (tenofovir DF) is actually used internationally to treat hepatitis B!

With regards to use of PrEP, the author suggests that additional information is required on long-term side effects and its effectiveness before we should consider its use in Ireland. In fact, the European Medicines Agency approved use of Truvada in HIV prevention based on a wealth of data in this area, including two large European clinical trials that both demonstrated that adding PrEP to existing prevention strategies (such as increased testing and use of condoms) resulted in a further 85 per cent reduction in HIV transmission, with no unexpected safety signals, has been available for general use in the US for several years and is increasingly being introduced by other governments in Europe.

With 2016 data from the Health Protection Surveillance Centre showing new HIV diagnoses in Ireland exceeding 500 for the first time in many years, there is clearly an urgent need for better HIV prevention in the Irish setting.

Contrary to the author’s perception, in the two decades that I have been involved in HIV care, both in Dublin and in Sydney, I have never seen the gay, lesbian and transgendered community more engaged in taking responsibility for their own sexual health, through their vocal and active lobbying for access to the range of prevention tools that have been clearly shown internationally to be safe, acceptable and effective at reducing the risk of HIV transmission.

The use of fear-based education as a public health tool in sexual health simply has not worked in Ireland, as reflected not only by rising HIV notifications but also increased gonorrhoea diagnoses among younger women and the ongoing problem with high rates of syphilis.

The time really has come for the Government to take some meaningful action based on the wealth of evidence that is already available. – Yours, etc,

Dr PATRICK MALLON,

Head,

HIV Molecular

Research Group,

UCD School of Medicine,

Dublin 4.