Maryland: New HIV Prevention Drug May Not Be for Everyone

Maryland HIV/AIDS advocates and health officials expressed hope about the recent US approval of Truvada to prevent HIV infection, but their hopes were tinged with concerns.

"My concern is that this is not going to be a cure-all for all people at risk for HIV," said Dr. Oxiris Barbot, Baltimore's health commissioner. "The population driving the epidemic is not necessarily the one that is going to be utilizing Truvada to the greatest extent."

Costs would deter developing-country use of the drug to reduce HIV risk among the uninfected, said Dr. Robert C. Gallo, director of the Institute of Human Virology in Maryland. And many people in places such as Baltimore are uninsured and may not have access, either.

Baltimore has been aggressively targeting at-risk populations with testing campaigns. New HIV cases are rising fastest among men who have sex with men, while dropping for other at-risk groups such as IV drug users, city data show. Testing and condom use are crucial to stemming the infection rate, officials say.

For the approach to be effective, treatment adherence and risk-reduction counseling are both key. However, "When you are trying to look at who is on all cylinders, that is a small percentage," worries Eduardo Leon Guerrero, medical director at Chase Brexton Health Services in Baltimore. The approach might work especially well in certain groups, such as serodiscordant couples, he said.

"In order to manage my virus, I know that I have to take a daily regimen of pills," said a Towson man with HIV who did not want to be identified. "They go down like vitamins now. The person that is not infected is not equipped ... to think that way and may be more lax."

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