P1-17. Need for pre-exposition prophylaxis to HIV-1 in Sweden

Bo Hejdeman [1], Magnus Gisslén [2], Anders Sönnerborg [3], Göran Bratt [1 ] for the Swedish PrEP writing group and the Reference group for antiviral therapy (RAV)
Affiliates: [1] Venhälsan, Department of Infectious Diseases, South Hospital, Stockholm, Sweden. [2] Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden. [3]Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Background
Pre-exposure prophylaxis (PrEP) against HIV-1 using tenofovir/emtricitabine (TDF/FTC) has been analysed in several studies. In Europe two major studies have been finalized which included MSM and transgender persons. In the PROUD study TDF/FTC was given as 1 tablet OD and IPERGAY study TDF/FTC was given on demand, 2 tablets 2-24 hours before intercourse and thereafter one tablet for two days after the last sexual encounter. In both studies an 86% reduction of transmission rate was seen. The protection rate for women has varied in different studies.
The objective of this abstract was to investigate the present situation with regard to need of and access to PrEP in Sweden.

Method
An estimation was done on the predicted need for PrEP in MSM with high risk behaviour based on two or more episodes of sexual transmitted infections at any location; gonorrhea, chlamydia, lymphogranuloma venerum (the last two years) or syphilis (the last five years). The information was obtained from the national statistics of Public Health Sweden for STI and statistics for STI among MSM at the Gay Mens Health Clinic, South Hospital, Stockholm.

Results
Based on the assessment of rectally located STI and/or syphilis (any location) the last two years, 500 MSM per year were predicted to fulfill the criteria for the use of PrEP. Based on the WHO recommendation to use PrEP, together with other preventive measures, in populations where the HIV-incidence is 3 per 100 person-year or higher, this Swedish high-risk population should be offered PrEP.
When analysing the situation in Sweden, it was recognized that the Dental and Pharmaceutical Benefits Agency (TLV) approved the use of Truvada®, for this population, in October 2016. However, so far the issue of economical reimbursement has not been solved and the use of PrEP within health care has therefore not yet been implemented.

Conclusions
Our estimation is that around 500 MSM fulfill the criteria for PrEP (WHO as well as the Swedish Reference group for antiviral therapy). Since the reimbursement issue for drugs and health care costs are not solved, these MSM are still in high risk of becoming infected with HIV-1.