Plenary 1, Presented by Raphael Landovitz is available for viewing http://www.croiwebcasts.org/
The speaker address a number of the common concerns associated with PrEP:
- Decreased condome use, not being observed and high risk individuals self selecting for PrEP
- Resistance not emerging (at least in early data)
- Safety and adverse event (low and stop when PrEP stopped)
- Supporting adherence, needs to be multifaceted
- Optimal deployment is still to be determined
The big issue with all studies is that:
“Drugs don’t work in patients who don’t take them”
Interestingly Landovitz suggested that primary care providers are best placed to manage PrEP with their patients as they have long standing relationships and service negative patients. Specialists on the other hand see patients once they have HIV and may be in clinics which negative people avoid. He also suggested that generalists are least well equipped with information and education. This is a very interesting comment from the Australian perspective where so much HIV care happens in general practice.
He also suggested that optimal deployment will require a multi-pronged approach with information for health care providers, patients and from professional and clinical organisations and government providing clinical guidance. I recommend the talk, particularly for people wanting a comprehensive overview of contemporary PrEP science and implementation.