DEPARTMENT OF HEALTH

RESEARCH INSTITUTE FOR TROPICAL MEDICINE

Treatment as Prevention (TasP)

and Pre-exposure prophylaxis
(PrEP)
Rossana A. Ditangco, MD
AIDS Research Group
Research Institute for Tropical Medicine
Manila, Philippines

UPSIDA 6th Biennial Post Graduate Conference

10 August 2018 Hotel Jen Manila

1
UNAIDS Global AIDS Update 2018
HIV prevention strategies
note : must be used in combination

• Education
• HIV counseling and testing
• Condoms and lubes
• Needle and syringe program (NSP
• Use of antiretroviral drugs
- Prevention of mother to child transmission –
HIV + pregnant women
- Treatment as prevention (TasP)
- Post exposure prophylaxis (PEP)
- Pre- exposure prophylaxis (PrEP)
 TasP

U=U
What is the evidence?
The TasP game changer study
HPTN052
• Enrolled 1763 sero-discordant
heterosexual couple
• Early versus delayed ART
• Early ART 93% lower risk HR 0.07 95%
CI, 0.02-0.22
• No linked infection in stably suppressed
index participant
COHEN ET AL, Antiretroviral Therapy for the Prevention of HIV-1 Transmission N Eng J Med 2016
;375:830-9
 TasP
• Opposite attract 2012-2016
358 MSM (Thailand, Brazil, Australia)
condomless sex
undetectable viral load
0 (zero) infection
(IAS Conference on HIV Science 2017)
Partners of People on ART: a New Evaluation of Risks
(PARTNER STUDY 2)

• 2014-2018 MSM only

• Condomless sex on suppressive therapy
• 783 contributed 1596 eligible CYFU
• Years in the study, median (IQR) 1.6 (0.9-
2.9)
• ZERO linked transmission
Alison Roger HIV transmission through condomless sex in gay couples in suppressive ART: the
ARTNERS 2 extended results in gay men WEAX0104LB AIDS 2018
Prevention of mother to child
transmission
• Women and Infant Transmission Study,
22.6% in 1990- most women received no
ARV therapy or only ZDV
1.2% in 2003 - 87% received combination
therapy

Achievements in Public Health: Reduction in Perinatal Transmission of HIV Infection --- United States, 1985—
2005 MMWR June 2, 2006 / 55(21);592-597
Maximizing the benefit of ART
• To prevent AIDS and non AIDS related
complications
• Prevention of sexual transmission
• Prevention of mother to child transmision
• Timing of ART – early initiation
• Availability of safer, affordable and simpler
formulation
Revised Policies and Guidelines on the
Use of Antiretroviral Therapy (ART)
among People living with Human
immunodeficiency virus (HIV) and
HIV-exposed infants
 Sustainable Developmental Goals
(SDGs)
• Expansion of access to treatment
• Ending the AIDS epidemic as a public health
threat by 2030
• 90-90-90 targets
– 90% of the people living with HIV know their
status
– 90% of the people who know their HIV status are
receiving anti-retroviral therapy (ART)
– 90% of the people receiving ART are virologically
suppressed
 Strategic Approaches to Control HIV
• TEST EARLY
• TREAT EARLY
• TREAT ALL

• Remove limitations on eligibility for ART

among Filipinos living with HIV
 General Guidelines in Treatment
1. ART shall be initiated in all persons
with confirmed positive HIV test result
regardless of clinical and
immunologic status.
 Recommended Regimen for Adults
and Adolescents (≥10 years of age)
First line Regimen: 2 NRTI + 1 NNRTI

• Preferred first line NRTI: Tenofovir (TDF) + Lamivudine

(3TC)
• Alternative first line NRTI: Abacavir (ABC) + 3TC
Patients with estimated creatinine clearance of < 60 ml/min
ABC is preferred over TDF.

• First line NNRTI: Efavirenz (EFV)

• For patients where EFV is contraindicated, Rilpivirine is an
alternative NNRTI.
Pre-exposure prophylaxis (PrEP)
• Persons without HIV infection
• intake of 3TC/FTC plus tenofovir
• With substantial risk
Pre-exposure prophylaxis (PrEP)
• Examples of substantial risk are:
– Being a sexual partner of a PLHIV who is not virally suppressed,
– Had unprotected anal/vaginal/neovaginal sex in the past 6 months with
more than one partner,
– Sexual partner of a person with one or more HIV risk factors in the past
6 months,
– History of any STI in the past 6 months,
– Used drugs or alcohol for sexual pleasure or recreational purposes in
the past 6 months,
– People who injected drugs in the past 6 months
– Exchanged (received or given) sex for money, valuables, drugs or
favors in the past 6 months,
 PrEP efficacy: the evidences
• Heterosexual - 62.2% - 75%
Thigpen et al. Antiretroviral preexposure prophylaxis for heterosexual HIV
transmission in Botswana. The New England journal of medicine. 2012;367(5):423-
34.(TDF 2 Study)
Baeten et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and
women. The New England journal of medicine. 2012;367(5):399-410. (Partners PrEP
Study)

• MSM and TG - 44% (per protocol)

Grant et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex
with men. N Engl J Med. 2010;363(27):2587-99 (iPrEX)

• IPERGAY – 86% risk reduction (intermittent

PrEP)
Molina et al On demand pre-exposure prophylaxis in men at high risk for HIV1
infection N Engl J Med 2015;373:2237-46.
 PrEP adherence ≈ Efficacy

Grant et al Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in

men and transgender women who have sex with men: a cohort Lancet Infect Dis 2014;
14: 820–29 (iPrEX)
PROJECT PREPPY (PREP PILIPINAS)
A PILOT PROGRAM OF COMMUNITY-BASED PEER DRIVEN HIV PRE-EXPOSURE
PROPHYLAXIS FOR MEN WHO HAVE SEX WITH MEN IN MANILA , PHILIPPINES
SALAMAT PO
(THANK YOU)