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New infections in Germany: What good is HIV prophylaxis?

New infections in Germany: What good is HIV prophylaxis?

So far, Germany has failed to reduce the number of new HIV infections. Experts are watching with excitement as to whether a prophylactic drug can make a difference.

 The daily dose for HIV comes in small plastic bags. Since 2016, so-called pre-exposure prophylaxis, PrEP for short, has been approved in the EU .Usually, two active ingredients are combined in one tablet, tenofovir and emtricitabine – the therapy became known under the brand name Truvada.

According to the German Aids Society, this is particularly interesting for a small, high-risk group: men and transgender people who also have unprotected sex with men who change frequently, as well as partners of untreated HIV-infected individuals.

For a long time interested people had to order the drug from questionable sources abroad . But since October it is more affordable in Germany. The price dropped by an initiative of several hundred to 50 euros per month – pay him the recipients out of pocket. In the meantime, more than a thousand prescriptions have been redeemed, says HIV researcher Hendrik Streeck. He leads an accompanying study, which wants to pursue the question: Infect themselves from now on demonstrably fewer humans with the virus?

Especially many new infections in Berlin

In other countries, such as Great Britain, a decline has already been observed in this context. In Germany, on the other hand, the number of new infections has been stagnating for years. Last year, according to calculations published by the Robert Koch Institute (RKI), 2,500 men and 570 women were infected with the immunodeficiency virus. Berlin is severely affected, where Streeck now also counts many PrEP prescriptions.

Prevention with tablets is, as mentioned, intended for people with a particularly high risk of infection, not for everyone. The form of the application is quite new, but the drug itself has been approved for years for the treatment of HIV-infected people. It contains agents that inhibit virus proliferation in the cells and provides regular but high levels of protection against HIV, but not 100%.

People who want to take the drug must be sure that they are HIV-negative. If they use it despite already being infected, resistance threatens. Another danger: the tablets do not protect against other sexually transmitted infections such as syphilis . This medicine must pay attention to the users as well as possible side effects, such as the kidney. However, it is still not clear how this important monitoring can be ensured – because even here the signs point to self-pay.

The way to the PrEP leads so far only by specially trained physicians and 20- to 30-minute consultations in a pharmacy involved in the project. When buying customers get information material and answers to questions about the correct intake and the reference to the study by Hendrik Streek of the University of Duisburg-Essen.

Users with above-average income

 What does the researcher know about users thanks to the online questionnaire? So far, it was rather people with above-average income who made the PrEP, says Streeck. Some of them had already moved in from abroad, but in part they did not have any experience with it.

Respondents have often stated that they have not used condoms before and have had other sexually transmitted diseases, says Streeck. As a reason for condom renunciation called erectile dysfunction, but also the desire of the partner. The motives for the interest in the PrEP were mixed. “Many want additional protection,” says the researcher. He wants to take stock in at least one year.

The Berlin pharmacist Claudia Neuhaus paints a different picture. “These are very conscientious people,” she says of the PrEP users. They claim to use condoms despite the medication. Especially in relationships in which a partner is HIV-positive, it is about additional protection, for example, if the condom ruptures.

Pharmacies earned about ten euros on the drug, says Neuhaus. Because of the time-consuming advice, the bottom line is nothing left. “This is pioneering work, we want to minimize the spread of HIV.”

HIV / AIDS – the facts

In normal body contact, however, there is no risk of infection because the body skin, in contrast to the mucous membrane has a protective horny layer. In case of injuries or eczema, however, pathogens can also penetrate here. When dealing professionally with colleagues in the workplace there is as little risk of infection as when visiting the swimming pool or sauna or eating together. There is no risk in medical and dental treatments, as the disinfection of instruments reliably kills the virus.

The numbers should go down, Erik Tenberken is also the target – it is now necessary to stabilize the supply of PrEP. The Cologne pharmacist has a company in which medicines are packaged individually for patients in small bags, especially in order to facilitate the intake in old people’s homes. Manufacturers can grant discounts to such a blister center, but not pharmacies.

Tenberken took advantage of this detour and brought more pharmacies with HIV expertise on board, which was welcomed by medical professionals. Further initiatives may be underway, according to Tenberken. In the Ruhr area, for example, there is another approach to the PrEP levy, but with still manageable numbers of users.

 The RKI writes in a recent report, “It will be interesting to see how many people are taking advantage of this new opportunity, and whether the number of PrEP users is growing so high that it affects the numbers of new HIV infections.”

A look to France suggests that there is probably, even more, need in Germany: There bend Hendrik Streeck about 4500 people with the PrEP, but it can also be taken over by the coffers there. A takeover of the costs here, the German Aids-Hilfe calls for some time. And the German Association of practising physicians in the care of HIV-infected (Dagnä) calculated that the prophylaxis was more favorable than the long-term treatment of HIV-infected people. There are thousands of cases that could be avoided over the next few years.


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