Karen Ocamb

New Study: AIDS Risk Lessened by Daily Drug

Filed By Karen Ocamb | November 23, 2010 5:00 PM | comments

Filed in: Living

A new study sponsored by the U.S. National Institutes of Health, published Nov. 23 in the New England Journal of Medicine finds that gay men and transgender women who have sex with men and are at high risk of HIV infection who took a single daily tablet that combined two already widely used HIV medications, emtricitabine and tenofovir, experienced an average of 43.8 percent fewer HIV infections than those who took a placebo. While the study, called iPrEx, is being hailed as a new HIV prevention treatment strategy, others are concerned about the ethics of using placebos on non-infected individuals.

CNN reports:

Researchers have shown for the first time, that a combination of two antiretroviral drugs taken daily reduces the risk of HIV transmission in men and transgendered women having sex with men. In the study, New England Journal of Medicine, nearly 2,500 men were given either an oral combination of two widely used HIV medications (emtricitabine and tenofovir) or a placebo.

The risk of infection was reduced by almost 44 percent in the group getting the drugs. The risk was reduced even further- almost 73 percent -in study participants who took the drugs for most of the year.

“We now have strong evidence that pre-exposure prophylaxis with an antiretroviral drug, a strategy widely referred to as PrEP, can reduce the risk of HIV acquisition among men who have sex with men, a segment of the population disproportionately affected by HIV/AIDS,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the Institutes of Health.

Additional research is needed, but certainly this is an important finding that provides the basis for further investigating, developing and employing this prevention strategy, which has the potential to make a significant impact in the fight against HIV/AIDS,” Fauci tells CNN.

Researchers found people who took the PrEP pill regularly-at least 90 percent of the year -actually reduced their risk of infection by more than 70 percent. Side effects were minor."

Additionally, researchers found no evidence of drug resistance.

(Please find more information inside, especially regarding Black gay men, and a video report from ABC News.)

Dr. Michael Saag, director, Center for AIDS Research at the University of Alabama at Birmingham, and Immediate Past President of the HIV Medical Association, told CNN that he is concerned about exposing uninfected people to drugs that he says are known to have potentially harmful side effects, no matter how uncommon, and whether it’s cost effective.

“With the limited resources around the U.S., I would much rather see us spend our money finding the 25% of people in the country who are HIV infected but don’t know their status.”

Saag believes getting them tested and treated is more important. “Outside of the benefit to them for their own health there would be a definite prevention benefit to society because that 25 percent of people who don’t know their status are responsible or over 60% of the new infections per year - roughly 30,000 new cases per year - and to me it would be much more beneficial to put our efforts in that area before we start figuring out ways to pay for medicine to protect a relatively few number of new cases through PrEP,” Saag says.

As writer Rod McCullen notes, young black gay and bisexual men are the group most unaware of their HIV status.

There are other issues, of course, such as cost - especially with the drug mark up in America. However, the generic version for Africa - especially for women who cannot tell their promiscuous husbands or boyfriends to use a condom - may be less expensive and life-saving. There are still efforts underway to find a vaccine - but no idea if and when a successful vaccine might be found. The Centers for Disease Control has a webpage explaining the need for PrEp research.

Longtime lesbian healthcare writer and journalism professor Linda Villarosa wrote a post for the Black AIDS Institute on the study, concluding with:

"In the wake of today's research, scientists are already working to figure out how best these finding will translate into real life, for real people. Meanwhile, correct and consistent condom use and a reduced number of sexual partners remain the most effective ways for gay and bisexual men–and everyone–to protect against HIV infection."

Meanwhile, the Pope has finally agreed that condom use by male hookers are helpful in preventing the spread of HIV. OK for some women, too.

Here’s an ABC News report on the study:

Crossposted from LGBT POV

AIDS Medication Photo courtesy The Black AIDS Institute

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Those are good results, but I wonder how this works as a public policy. How do they get so many people to take so many drugs?

And at what cost? That's all profit for the drug companies who make their money off our sickness.

I can understand how someone with HIV might decide that the physical problems (often quite severe) caused by these antiviral drugs are worth it to keep from dying, but it's a very different deal to put up with the side effects just to (maybe) prevent infection. It's an interesting study, but I can't see the practical use.

In countries with very high rates of HIV infection these drugs may prove invaluable in cutting the rate of new infections. If they work well, and they seem to, Brazilians and South Africans will probably 'discover' their own versions, tell Big Pharma to go to hell and produce their own, distributing them free or at a nominal cost.

In this country, which has a health care system dedicated to healthy profits not healthy people, State Boards of Pharmacy can direct you to Canadian, English and Indian sources for these drugs. Expect a longer delivery time because of customs.

From a scientific standpoint, the results are not all that surprising. Anything that can fight against an innoculus of HIV establishing an ongoing infection in a new host is likely to reduce the infection rate markedly. In fact, IMHO, it is surprising that a study such as this one has not be conducted earlier.

Steve, Alex, and Bil, maybe we need to acknowledge that this is a scientific report, and the public policy implications are not yet worked out. But nothing here changes the standard safe sex education guidelines that need to be disseminated to sexually active gay men, who usually can choose to use a condom if they are open to that possibility, and ideally can discuss HIV issues with their partners before sex.

The study resultsh more applicable to situations where a person can't control whether their partner uses a condom, and doesn't have reliable info about their partner's HIV status. Some African wives are a prime example -- but we must admit that some American wives, and wives in any country, can be in the same boat, and even some gay men.

Because of cost, and because other, more effective options are available, I hate to see PrEP become a standard in the American gay male community, instead of a re-doubling of our current prevention efforts. But I fear that it will. Americans are too eager to substitute a pill for common sense and good character.