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.
"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."
San Francisco Chronicle
12.09.2010; Erin Allday
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