Interview with Dr Pascale Perfezou, head of the public health center, responsible for the HIV unit and the PrEP (pre-exposure prophylaxis) consultation, at Quimper hospital (Finistère).
We can hear: “We protect ourselves less with condoms. » Is this true?
If we only talk about condoms, that’s for sure. However, this is not the only way. We know well that for certain acts, such as fellatio, a condom is never used.
However, syphilis is caught like that, gonococci too or chlamydia (1). Even more so with practices, such as chemsex (sexual activity coupled with drug use), which can promote disinhibition.
Today there is PrEP, a preventive treatment. What is this ?
PrEP is two molecules in a single tablet, Tenofovir and Emtricitabine. These are molecules that we have known about for a while since they are used to treat HIV-positive people.
Read also: More than 4,000 people are affected by HIV in Brittany
Alongside this use, studies began more than ten years ago in several countries in Africa, Europe and North America to see if, by taking these molecules preventively, we could prevent contamination. All are unanimous on its effectiveness.
Are there several ways to take PrEP?
If you take it preventively and optimally, that is to say one tablet every day continuously, you do not catch the virus. PrEP can also be taken occasionally, on demand, in certain cases. The cells of the mucous membranes “load” with antiviral molecules.
Thus, if the virus enters the mucous membranes, a drug army is set up and it will not be able to develop.
You confirm, PrEP is a revolution?
Yes. And we should be able to prescribe PrEP to anyone who may be at risk, at some point in their life, of encountering the virus… Coupled with the fact that when we are treated as HIV-positive or HIV-positive, we no longer transmit the virus, then we could succeed in eradicating HIV from the world. We must think about people in prostitution, people in migration, who are very vulnerable to the virus.
Is PrEP free?
This is 100% covered by social security. The CeGIDD (free screening center) is a gateway. People come there to be tested but also to be consulted. We try to understand what leads them to do such screening, we discuss the risks taken and we explain the different methods of prevention, including PrEP. It is common for PrEP to be prescribed when the results are returned.
Can the treating doctor also prescribe PrEP?
Yes, including primary treatment, which was not the case two years ago. If attending physicians do not feel comfortable with this prescription, there are online training courses, which are quite comprehensive and free. It’s called FormaPreP.
A telephone line is being set up in Brittany…
Yes, we will soon be doing a sort of telephone watchtower within the CoReSS (coordination committees for the fight against HIV and sexually transmitted infections) in the context of HIV and STI screening without a prescription, to provide helps biologists who are at the forefront of screening, particularly in laboratories.
Are there any side effects?
The concern concerns patients who already have kidney failure because we cannot afford to prescribe a drug with a risk in this area. There is another molecule, cabotegravir, cabotegravir which is administered by intramuscular injection. It is an antiretroviral, which is beginning to be used in the United States as PrEP.
In France, it could be but at the current price, we cannot have marketing authorization. We can sometimes obtain it but I only managed to obtain the exemption for one patient here. For around 400 patients who benefit from preventive treatment. Every week we have new Preparer patients.
A treated person does not transmit the virus. But serophobia remains…
It’s a truly idiotic phobia. It is absolutely necessary to remember that a person who is HIV positive and treated cannot transmit HIV. It’s 100% certain.
You have been following certain HIV patients since the 1990s…
I have certain patients that I have known since I was there, that is to say 1994. Some are likely to develop more diseases than the average because at the beginning of their treatment course, the molecules which allowed them to live were also very toxic to their bodies.
Treatments have progressed a lot, are less mutilating, with fewer side effects. Some people say they forget about their HIV at times. That’s a big victory.
(1) Since 1is September 2024, direct access to screening for other sexually transmitted infections (STIs) than HIV is possible at the patient’s request, without a prescription and without an appointment, in all medical biology laboratories, including medical laboratories. health establishments.
