Abstract
Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).
Highlights
The 5th of June 2021 marked the sad 40th anniversary of the medical description of the first cases of acquired immunedeficiency syndrome (AIDS), back in 1981 in Los Angeles in the United States of America (USA)
In July 2016, European Medicines Agency (EMA) recommended to the European Commission granting marketing authorization in the European Union (EU) for emtricitabine/tenofovir disoproxil to be used for Pre-exposure prophylaxis (PrEP) “in combination with safer sex practices to reduce the risk of sexually acquired human immunodeficiency virus (HIV)-1 infection in adults at high risk” (19)
This study identified that at least in this European population, the determinants of event-driven PrEP or post-exposure prophylaxis (PEP) were (51): i) older age; ii) less situations of condomless anal sex episodes; iii) not taking any other daily medications, and; iv) being involved in a stable relationship
Summary
Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM).
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