Windy City Media Group Frontpage News
Celebrating 30 Years of Gay Lesbian Bisexual and Trans News
home search facebook twitter
Gay News Sponsor Windy City Times 2015-07-22
DOWNLOAD ISSUE
About WCMG Publications News Index  Entertainment Features Bars & Clubs Calendar Videos Advertisers OUT! Guide    Marriage


  WINDY CITY TIMES

HIV drugs can prevent infection
by Bob Roehr
2010-12-01

facebook twitter del.icio.us stumble upon digg google +1 reddit email


HIV drugs can do a remarkable job of suppressing high viral loads to undetectable levels, but can they prevent that infection in the first place? Most people thought that they could in theory but there was no proof of that … until now.

Results from the Preexposure Prophylaxis Initiative ( iPrEx ) Trial found that drugs could reduce new infections by 43.8 percent in the high-risk men who have sex with men ( MSM ) and transgender persons in the study. It was published in the New England Journal of Medicine Nov. 23.

The $43.6-million trial enrolled 2,499 participants at 11 sites on four continents, including San Francisco and Boston in the United States. Despite the fact that MSM are much more likely to be infected with HIV—they are more than half of those infected in the US and in the broader epidemic of sub-Saharan Africa they are at least four times as likely as their heterosexual counterparts to be infected with the virus—this is the first large biochemical prevention study conducted in MSM.

Participants were randomized to receive once a day dose of either Truvada, a single pill containing the drugs emtricitabine and tenofovir, or placebo, essentially a sugar pill with no active ingredients. They also received counseling on HIV prevention at every meeting with the study team. The analysis was based on a median of 1.2 years on the drug.

Of the first 100 people to become infected with HIV, 64 were receiving placebo ( an annual infection rate of about 4 percent ) and 36 were on Truvada. The 43.8 percent rate of protection was no home run but within the same ballpark as the protection seen in other recent prevention trials; the vaginal microbicide trial of tenofovir gel in African women ( 39 percent ) and a vaccine trial in Thailand ( 31 percent ) .

Adherence

Digging deeper, the researchers found that adherence was a very important part of the equation. The men who took at least half of their doses had 50.2 percent fewer infections; those who took at least 90 percent of their medication had 72.8 percent fewer infections. Even the best drugs will not work if people don't take them as they should.

Robert Grant, M.D., is a researcher at the Gladstone Institute at the University of California San Francisco and the principle investigator of the study. He said they asked participants to report how often they took their pills, but because people often are "optimistic" in their recall, and sometimes report what they think researchers want to hear, the study also tested for levels of the drug in the blood of those who became infected.

"No drug was detected in 91 percent; the other 9 percent had detectible levels inside blood cells that were very low. The absence of drug in the blood is probably due to people not taking the drug, which could explain all of the infections that did occur" in that group, Grant said.

The association between adherence and the level of protection was similar to what was seen in the microbicides trial. People who most closely used the product as intended had the best results. Cutting corners gave HIV an opportunity that it quickly exploited.

Reactions

"The iPrEx study results are extreme important and provide strong evidence that PrEP [ preexposure prophylaxis ] can reduce HIV acquisition among a segment of society disproportionately affected by HIV/AIDS," said Anthony Fauci, MD, director of the NIH National Institute of Allergy and Infectious Diseases. It provided $27.8 million toward the study.

He emphasized that despite this good news, "correct and consistent use of condoms and a reduction in the number of sex partners still remain the most effective ways to protect yourself from HIV infection."

"This is great news," said Thomas J. Coates, Ph.D., a leading international HIV prevention researcher at the University of California Los Angeles David Geffen School of Medicine. "But if it would have been any lower, I would have been devastated."

University of Pittsburgh HIV prevention researcher Ronald Stall, Ph.D., called the results "very good news for gay men and other populations at high risk of HIV transmission." It also points to the continued need for better behavioral interventions to support adherence.

Money

Gilead Sciences manufactures Truvada and supported the iPrEx study by providing all of the drugs used. The company said it "will be working with the appropriate regulatory agencies to determine if data from this study warrant inclusion in the prescribing information for Truvada."

While doctors can prescribe drugs for "off label" use that the FDA has not approved, and some already prescribe Truvada for prevention, health insurance companies generally only reimburse for the use indicated on the label of the drug.

Adding a prevention indication to the drug label likely will require additional trials in MSM and other populations, particularly with regard to preventing vaginal transmission of HIV. Some of those studies already are underway.

"The big conundrum right now is what does it mean for practice?" Coates said the response was not sufficiently great to signal immediate widespread adoption of this approach as a prevention intervention, particularly given issues of cost.

The retail price of the drug in the United States is about $14,000 a year, while the NIH pharmacy purchases it for about $5,000 a year, Fauci said.

In developing countries, generic versions of Truvada can be purchased for as little as 40 cents a day, according to Grant. However, those are the same places where more than half of the people already infected with HIV, who meet guidelines to begin treatment, cannot do so because of the cost. It is unlikely that public health officials will devote scarce resources to Truvada when a condom will do the same job much more cheaply.

Furthermore, an international survey of more than 5,000 participants, to be released next week by the Global Forum on MSM & HIV, found that more than half of MSM worldwide do not have access to basic HIV prevention and treatment services. Adding PrEP to the mix will be a challenge.

The paper "Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men" is freely available from the New England Journal of Medicine at www.nejm.org/doi/full/10.1056/NEJMoa1011205.


facebook twitter del.icio.us stumble upon digg google +1 reddit email




Windy City Media Group does not approve or necessarily agree with the views posted below.
Please do not post letters to the editor here. Please also be civil in your dialogue.
If you need to be mean, just know that the longer you stay on this page, the more you help us.


  ARTICLES YOU MIGHT LIKE

CDC awards $3.8 mill to local agencies for 5 year HIV prevention partnership 2015-07-24
Protestors decry HIV/AIDS cuts 2015-07-22
amfAR launches comprehensive database of planned HIV/AIDS funding 2015-07-22
Upcoming: Sports hall of fame; Auction of Jenner torch; AIDS Run & Walk 2015-07-22
Chicago House awarded comprehensive federal HIV grant 2015-07-17
Man gets 30 years for HIV exposure 2015-07-17
AIDS Run & Walk Chicago to support 36 HIV/AIDS groups 2015-07-17
Man gets 30 years for HIV exposure 2015-07-14
HIV doctors, lawyers, community call for reform of Missouri HIV law 2015-07-13
Ride For AIDS Chicago raises $600,000 2015-07-13
Smithsonian adds AIDS research pioneer Krim's portrait 2015-07-10
Participants prepare for Ride for AIDS Chicago 2015-07-07
PrEP advocates respond to AHF ads 2015-06-21
Zachary Quinto Joins Foundation for a National AIDS Monument Board 2015-06-12
Free HIV testing June 14 2015-06-12
Open Door to hold Grand Opening of Elgin Health Center 2015-06-04
Study to look at quality of life for older, rural HIV-positive adults 2015-06-04
Chicago House, Center on Halsted deny merger talks 2015-06-03
Harmony, AFC bring awareness to testing, treatment, holistic health needs 2015-06-03
Daylong summit to focus on long-term HIV/AIDS survivors 2015-05-31
Missouri HIV case gets national attention 2015-05-20
Gay HIV-positive singer lives life out loud 2015-05-20
AFC marks thirty years of action 2015-05-17
Black gay man found guilty by Missouri jury of "recklessly infecting" 2015-05-15
Health news: HIV/AIDS column; HIV/AIDS Response Act; HBHC seeks boardmembers 2015-05-13
HIV guide targets high numbers of new infections 2015-05-07
Spring brunch gets in 'Vogue' 2015-05-04
Bill to reduce HIV testing barriers advances 2015-05-01
Sidetrack event aids Cubans 2015-04-26
Chicago Red Dress Party readdresses HIV/AIDS awareness 2015-04-21
AFC: Rauner gets failing grades on HIV/AIDS issues 2015-04-20
Monthly 'Positive Thoughts' HIV/AIDS column launched 2015-04-14
HIV/AIDS advocates ready for budget fight 2015-04-12
AFC hosts first-ever virtual advocacy day 2015-04-08
AFC forum at Center to deal with Rauner budget 2015-03-31
Office of Nat'l AIDS Policy hosts HIV/AIDS Strategy Regional Forums 2015-03-28
HIV advocates hail Coventry Health Plan improvement to drug access 2015-03-27
Lambda, packaging company: HIV-positive employee posed no safety risk 2015-03-26
Larry Kramer honored by Gay Men's Health Crisis 2015-03-25
Red Pump Project throws fashion show 2015-03-24
 



Copyright © 2015 Windy City Media Group. All rights reserved.
Reprint by permission only. PDFs for back issues are downloadable from
our online archives. Single copies of back issues in print form are
available for $4 per issue, older than one month for $6 if available,
by check to the mailing address listed below.

Return postage must accompany all manuscripts, drawings, and
photographs submitted if they are to be returned, and no
responsibility may be assumed for unsolicited materials.
All rights to letters, art and photos sent to Nightspots
(Chicago GLBT Nightlife News) and Windy City Times (a Chicago
Gay and Lesbian News and Feature Publication) will be treated
as unconditionally assigned for publication purposes and as such,
subject to editing and comment. The opinions expressed by the
columnists, cartoonists, letter writers, and commentators are
their own and do not necessarily reflect the position of Nightspots
(Chicago GLBT Nightlife News) and Windy City Times (a Chicago Gay,
Lesbian, Bisexual and Transegender News and Feature Publication).

The appearance of a name, image or photo of a person or group in
Nightspots (Chicago GLBT Nightlife News) and Windy City Times
(a Chicago Gay, Lesbian, Bisexual and Transgender News and Feature
Publication) does not indicate the sexual orientation of such
individuals or groups. While we encourage readers to support the
advertisers who make this newspaper possible, Nightspots (Chicago
GLBT Nightlife News) and Windy City Times (a Chicago Gay, Lesbian
News and Feature Publication) cannot accept responsibility for
any advertising claims or promotions.

 

 

 

TRENDINGBREAKINGPHOTOS

Sponsor
Sponsor
Sponsor
Sponsor
Sponsor


 



Sponsor

About WCMG Publications News Index  Entertainment Features Bars & Clubs Calendar Videos Advertisers OUT! Guide    Marriage



About WCMG      Contact Us      Online Front  Page      Windy City  Times      Nightspots      OUT! Guide     
Identity      BLACKlines      En La Vida      Archives      Subscriptions      Distribution      Windy City Queercast     
Queercast Archives      Advertising  Rates      Deadlines      Advanced Search     
Press  Releases      Event Photos      Join WCMG  Email List      Email Blast     
Upcoming Events      Todays Events      Ongoing Events      Post an Event      Bar Guide      Community Groups      In Memoriam      Outguide Categories      Outguide Advertisers      Search Outguide      Travel      Dining Out      Blogs      Spotlight  Video     
Classifieds      Real Estate      Place a  Classified     

Windy City Media Group produces Windy City Queercast, & publishes Windy City Times,
The Weekly Voice of the Gay, Lesbian, Bisexual and Trans Community,
Nightspots, Out! Resource Guide, and Identity.
5315 N. Clark St. #192, Chicago, IL 60640-2113 • PH (773) 871-7610 • FAX (773) 871-7609.