The government has granted insurance benefit to Gilead’s Truvada (tenofovir disoproxil fumarate/emtricitabine) for pre-exposure prophylaxis (PrEP) for people who are negative in HIV-1 infection but at high risk due to sex with an HIV-positive partner.

However, limiting the scope of people eligible for reimbursement of the drug will do little to help reduce new HIV infections, an expert said.

The U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Korean Society for AIDS recommend PrEP as one of the HIV/AIDS preventive measures, including HIV screening, early treatment, post-exposure prophylaxis, male foreskin removal, and condom use.

Korea Biomedical Review met with Kim Yeon-jae, infectious disease specialist at the Center for Infectious Disease at National Medical Center, to hear about what the PrEP reimbursement meant.

Kim Yeon-jae, infectious disease specialist at the Center for Infectious Disease at National Medical Center, speaks during a recent interview with Korea Biomedical Review.

Question: The Ministry of Health and Welfare gave the nod for Truvada as PrEP in June. What kind of clinical impact does it have?

Answer: “An HIV-negative sex partner of HIV-1 positive patient” gets 70 percent reimbursement for PrEP. However, limiting the treatment scope to such a population will not significantly help lower new HIV infections.

In the U.S., the so-called “U=U” (Undetectable=Untransmittable) campaign is already well known. It means that if the number of viruses goes down to an undetectable level, it is not transmitted to other people. A massive study on couples consisting of HIV-positive and HIV-negative partners was published on Lancet. The results showed that viruses well suppressed in HIV-positive people do not spread to HIV-negative people.

When the U=U campaign is spreading wide, and when local HIV patients are suppressing viruses well, it is quite regrettable that the government limited the beneficiary of the PrEP reimbursement only to “a sex partner of a person with HIV-1 infection.” Usually, partners of HIV-positive patients whose viruses are well suppressed are safe. The Korean Society for AIDS argued that the reimbursement should be available to “men who have sex with men” (MSM) who are at high risk. However, the situation did not turn well.

Q: Do you think PrEP reimbursement should be expanded?

A: Yes. The effect of curbing new infections will be limited if the reimbursement is available only for people who have HIV-positive partners with good viral suppression. Since the MSM group has the most significant risk, the reimbursement for the preventive HIV drug should be expanded for such a group.

When it comes to HIV prevention drug, Koreans ask two things. One is “Is HIV preventable,” and the other is, “Why do we have to support preventive drugs for them.” People are not happy with the government’s recommendation for hospitals to get HIV treatment expenses directly from the health authorities, instead of getting paid from the patients and seeking reimbursements later.

But this system is essential to prevent the spread of HIV infection. While the government is pushing for the system, social awareness is still falling behind.

Q: What should people remember when they are prescribed with PrEP?

A: Drug compliance is the most important thing in PrEP therapy. If the compliance is maintained normally, the risk of HIV infection can go down by more than 90 percent. In an extensive study, the preventive effect in the entire group was lowered only by about half but that in the group with a maintained level of preventive drug in the blood had over 90 percent reduction in the HIV infection risk.

There is one more thing I’d like to emphasize. Opponents of the FDA approval for Truvada said, “The preventive drug would create sexual abuse.” Thus, it is essential to educate people to make sure that they do not think it is safe to have promiscuous sex just because they are on the HIV prevention medication. When physicians prescribe the prevention drug, they must educate the patient. They also emphasize that patients should still use condoms even when they receive PrEP.

Q: What should be done to improve HIV treatment? Which part is most vulnerable?

A: The most vulnerable part is social prejudice, which is much more serious than we think. Not only ordinary people but healthcare professionals are still biased against people with AIDS. HIV patients can’t visit the hospital with ease out of fear that physicians might refuse to treat them.

Many feel discriminated during a visit to the hospital, even when they are not discriminated. For example, healthcare workers wear gloves when they collect blood from patients. However, some HIV patients complain if they wore gloves just because they were infected with HIV.

For such reasons, the National Human Rights Commission of Korea issued a recommendation to educate medical personnel to resolve discrimination and prejudice against HIV-positive people. The Korea Centers for Disease Control and Prevention conducts training for physicians at all state-run medical institutions across the nation through a contractor.

kym@docdocdoc.co.kr

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