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California: Preventive Drug Brings Promise -- and Questions

December 13, 2010

San Franciscans cheered last month's news that a combination antiretroviral already prescribed to treat HIV also prevented many new infections in a randomized trial involving 2,499 HIV-negative men who have sex with men. MSM given prevention counseling, condoms, and emtricitabine plus tenofovir (marketed together as Truvada) had a 44 percent reduction in HIV risk. Among those with 90-plus percent adherence to the once-daily regimen, HIV risk was reduced by roughly 73 percent.

However, questions about the efficacy and ethics of pre-exposure prophylaxis (PrEP) are still being debated, and San Francisco will figure centrally in that discussion. CDC is in the process of developing guidelines for PrEP.

In San Francisco, public health officials and advocacy groups have been holding community meetings to discuss the PrEP trial, which included 120 MSM from the city.

"We have a responsibility to work with the HIV/AIDS community on this potentially exciting intervention," said Dr. Grant Colfax, the city's HIV prevention director. "We have a very active community that is very engaged in health care, HIV prevention, and treatment."

While PrEP proved effective among MSM, it could be less so among women or intravenous drug users. Because PrEP was not 100 percent effective, condom use would still be critical to prevent infection. In addition, people seeking PrEP would need to ensure they are HIV-negative before taking the drug, and continue getting tested regularly for STDs and HIV. The protection offered by PrEP was most degraded by non-adherence, and Truvada's $12,000 annual cost is a barrier -- especially for the young, uninsured, and non-wealthy.

"The researchers will say that they badgered study participants, chased them around with counseling and condoms," said Judy Auerbach, executive director of the San Francisco AIDS Foundation. "In the real world, when you get outside the research setting, that's going to be harder to do."

Back to other news for December 2010

Adapted from:
San Francisco Chronicle
12.09.2010; Erin Allday

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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