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cant agree : truvada as PrEP
Jul 17, 2012

hi Dr benjamin, i partly disagree with the approval of truvada as preexposure prophylaxis medication in sexually high risk individuals. if u think socially and psychologically, people who visit brothels regularly can generally be considered as either indisciplined or ignorant or both (counter me if u feel i am wrong at this point please). and this is not a very wise decision to think that they will do a three monthly hiv screening while on truvada as PrEP. drug resistance will emerge from this cohort of people within months or years. i relly cannot support such approval and sorry for making the statement that it is company's strategy to increase the sale of truvada simultaneously putting the globe at risk of emtricitabine (along with lamivudine) and tenofovir resistance (so atripla/viraday will also fail eventually). what is ur opinion? am i wrong? regards from a doctor. Dr Titas (from india).

Response from Dr. Young

Hello Dr. Titas and thanks for posting from India.

I have to respectfully disagree with you about the recent FDA approval of Truvada for pre-exposure prophylaxis. First, my bias- I'm all for any scientifically sound strategy that increases the tools that we have to decrease new cases of HIV (and to decrease the disease burden of those who are infected). To this end, the data on the effectiveness and safety of Truvada PrEP meets my standard (and that of the US FDA).

People get HIV from a variety of behaviors, and mine is not to judge how one might be at risk, but rather to equip those who are willing to engage prevention and harm reduction tools with as many as are relevant and acceptable to the individuals. Surely you would endorse the use of condoms by (or with) commercial sex workers, wouldn't you?

While we don't yet know the full language of the FDA recommendation, it's clear that in order to receive biomedical interventions (PrEP), the patient would have to be willing to be adherent to the medication and medical follow up- including regular HIV antibody testing.

You rightly raise the question of the potential for the selection of drug resistance. In the multiple PrEP clinical trials, emergent drug resistance simply did not appear to be problematic. This is simply and probably related to the simple prelate that people to acquired HIV didn't take PrEP (and therefore, there also wasn't sufficient drug to select resistance), while those people who were adherent to the medication also had sufficient drug levels to prevent infection.

There are plenty of reasons why PrEP may face challenges (cost, scalability for example) that may limit it's use in all communities. But for now, I do indeed care for at risk individuals (including many who, as you might say, don't visit brothels) who want more than abstinence or hope that the condom won't break.

For a different but sage and expert viewpoint on the FDA approval, I'd suggest reading my friend and colleague Dr. Kenneth Mayer's opinion piece from the Huffington Post.

Be well, and thanks again for posting your opinion. BY



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