New York Forum: Can Drugs Prevent HIV?

On April 25, New York City's Lesbian, Gay, Bisexual, and Transgender Community Center hosted a forum about daily pre-exposure prophylaxis (PrEP) -- the continuous use of AIDS drugs to reduce contingent risks of sexually transmitted HIV infection.

"The studies that have been done so far have been done in animals and are based on theoretical models," said Richard Jeffries, director of basic science, prevention, and vaccines at Treatment Action Group (TAG), a forum sponsor. "Obviously, the big question is what will happen in people? What kind of toxicities will we see?"

One US study is enrolling 400 gay or bisexual men in Atlanta and San Francisco for a 24-month controlled safety and efficacy trial of tenofovir for PrEP. It will also monitor for adherence issues and any sexual risk changes.

"We're not talking about the evening before or the morning after," said Dr. Albert Liu, director of HIV Prevention Studies at San Francisco's Department of Public Health, a study site. "We're talking about a continuous dose."

In Peru, a controlled trial enrolling 1,400 gay or bisexual men will test truvada (tenofovir and FTC) PrEP for 20 months. In Thailand, Ghana, and Botswana, 3,200 men and women will test the PrEP efficacy of either truvada or tenofovir.

Last year, at least six mainstream press articles discussed the fact that some gay men are already using HIV drugs for PrEP. A 2005 CDC survey of San Francisco gay men found that 7 percent reported using drugs for PrEP "at some point in the past," said J. Jeff McConnell, a co-investigator of the Peru study.

"We're definitely not a cheerleader for PrEP," clarified panel member Raffi Babakhanian of the Community HIV/AIDS Mobilization Project (CHAMP), the forum's primary sponsor. "I don't think we're at a point where anybody can be a cheerleader." "There isn't a clear corollary" to PrEP, said Edd Lee, director of community education and outreach at the AIDS Vaccine Advocacy Coalition, which also sponsored. "That's why this research is so new."

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