Advances in HIV management and challenges in Japan: Current situation of pre-exposure prophylaxis in Tokyo.

IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Daisuke Mizushima, Hiroyuki Gatanaga, Shinichi Oka
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Abstract

Since the world's first case series of human immunodeficiency virus (HIV) infection were reported, more than 40 decades have passed. The advancement of HIV treatment and prevention has progressed drastically. Especially, the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention has been proven by a number of trials and the number of new HIV cases has declined over the years due to the large-scale and rapid implementation of PrEP and universal HIV treatment in multiple countries. However, in Japan, PrEP is not approved or officially supported as of June 2024. Despite of the absence of top-down movement, men who have sex with men (MSM)-friendly private clinics initiated prescriptions of generic medicines for oral PrEP with necessary tests in Tokyo, which greatly contributed to improve access to PrEP. It is of note that current situation of bottom-up PrEP implementation using generic medicines in Tokyo is obviously cost-saving, which is needless to evaluate. However, expense of PrEP is fully out-of-pocket, which will hinder those with low or no income from accessing PrEP services despite the low prices of generic medicines. Furthermore, current PrEP implementation based on user-friendly clinics is functioning only in Tokyo. The role of public health authorities is important to solve these financial and geographical disparities in accessing PrEP services, without impairing existing virtues of accessibility and cost-saving in the current system.

日本在艾滋病管理方面取得的进展和面临的挑战:东京暴露前预防的现状。
自世界上第一例人类免疫缺陷病毒(HIV)感染病例报道以来,40 多年过去了。艾滋病的治疗和预防取得了长足的进步。特别是暴露前预防(PrEP)在预防艾滋病方面的疗效已被多项试验所证实,由于多个国家大规模、快速地实施 PrEP 和普及艾滋病治疗,艾滋病新病例的数量逐年下降。然而,在日本,截至 2024 年 6 月,PrEP 尚未获得批准或官方支持。尽管没有自上而下的运动,但在东京,男男性行为者(MSM)友好型私人诊所启动了口服 PrEP 非专利药品的处方,并进行了必要的检测,这极大地促进了 PrEP 的普及。值得注意的是,目前东京使用非专利药品自下而上实施 PrEP 的情况显然节省了成本,这一点无需评估。然而,PrEP 的费用全部由患者自付,这将阻碍低收入或无收入者获得 PrEP 服务,尽管非专利药品的价格很低。此外,目前以方便用户的诊所为基础实施的 PrEP 仅在东京运行。公共卫生当局的作用对于解决获得 PrEP 服务方面的这些经济和地域差异非常重要,同时又不损害现行制度中现有的可及性和节约成本的优点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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