Big news today is that Truvada, the combination HIV treatment has been approved for marketing as a PreEP or Pre Exposure Prophalaxis medication to help reduce the risk of HIV infection in “high risk individuals”.
This has been considered a big step forward after Truvada was deemed safe as PrEP in May this year.
As reported in the San Francisco Chronicle:
Truvada, made by Gilead Sciences in Foster City, was approved in 2004 to treat people already infected with HIV, but studies have shown the drug is also effective at reducing the risk of contracting the virus.
“It’s a huge milestone that could change the course of the epidemic,” said Dr. Robert Grant, a UCSF professor and a researcher with the Gladstone Institute for Virology and Immunology who led one of the two studies on which the FDA approval was based.
“The main challenge is for everyone to start thinking of HIV as a problem that can be prevented,” he said.
The daily pill is aimed at an estimated 415,000 Americans whose sexual activity puts them at the highest risk for contracting HIV, the virus that leads to AIDS. About 1.2 million Americans have HIV.
This news has resonated in Australia with Star Observer reporting:
National Association of People Living with HIV/AIDS (NAPWA) spokesman Bill Whittaker told the Star Observer the news was a “game-changer”.
“It’s really a dramatic development in the fight against HIV because for the first time we have a drug that can be used by HIV-negative people at high risk of becoming HIV-infected which will prevent infection or give a high level of protection against infection,” he said.
“We’ve never had that before.”
Whittaker added Truvada was not a “silver bullet” against HIV infection and needed to be used with condoms and other safe-sex practices…
Australian Federation of AIDS Organisations (AFAO) deputy CEO Simon Donohoe has also backed the call to immediately begin Truvada clinical trials in Australia.
“Truvada has the potential to make a significant dent in the HIV infection rate,”
Naturally there are a number of concerns about this step forward. Some questions I have include:
- Who is considered a “high risk individual” for HIV infection?
- Why is it that safe sex works for some people at not others?
- Is there a risk this could lead to further resistent HIV strains killing one of the key HIV treatments used in Australia?
- Who will pay for the $18,000 annual bill for this treatment? Will PrEP HIV prevention only be available to those that can afford it?
Clearly HIV prevention is a complex issue. While a once a day tablet sounds like the perfect solution for breaking the HIV cycle, will this help reduce the burdon of HIV worldwide or could it be a move by pharmaceutical companies to cash in on a market that has flattened with current patents coming to a close?
I’m sure the debate will continue.
Yours in good health.
Dr George
I am sceptible despite being HIV +. I have been in a serodiscordinate relationship for 8yrs. I would love to be able to have unprotected sex with my partner but at what cost?
We couldn’t afford $18,000 pa! How could we ask the government to fund our sex life? Already I am on Atripla, but if truvada failed I would be mortified should my man become positive too.
However, it is nice to think options are coming a reality as we have always believed one day we maybe able to simply have sex without reaching for the condoms.
The jury is still out in our household
You do realize that if you want “natural” serodiscordant sex, the most optimistic protective estimates of PrEP have not been observed to even approach the least optimistic estimates of just treating the poz person, don’t you? This is not a tool to bring serodiscordants closer, it is a recreational drug to facilitate sex with strangers of unknown medical history-and a pretty dangerous one at that. This has been a sad day for the integrity of the American FDA.
This is not a surprising day for the FDA. Let us not forget that the drug will be used by *people* Fallible, feeling people. We can hope for best practice but we must remember that everyone has their own definition of safe and acceptable risk. Mitch has a great point. We
It will get down to health economics in the end. If this drug reduces the overall long term cost of the growing burden of chronic disease in this country, I expect any government will seriously consider allowing it to be used for preventative purposes.
Are condoms working to stop prevention? Seems not as well as we would like them too. What’s wrong with considering all options?
Also, as a negative person, having fallen in love with and lived with a positive partner for 5 years, I would have welcomed the opportunity to make love naturally without fear of contracting HIV. I expect most in that situation would feel the same also.
I think you misunderstand. This does not mean you take a pill to not use a condom. You must still use condoms.
Being HIV + I can say this much Truveda helped me until I could no longer handle the side effects. If it works as a PrEP then all well and good but I don’t think of it as the “silver” bullet. Of course I’ve gone through numerous treatment regiments over the years and I’m starting to wonder what’s out there for me in the future.
I couldn’t have said it better. We already have antibiotic resistant strains of staph, do we really want to get a truvada resistant strain of HIV doing the rounds as well? Nothing has obviously been learnt from the antibiotic fiasco.
Add to that, what’s wrong with condoms? If there are subsections of the community who legitimately have issues with condom use, how will they go with taking this pill every day for the rest of their lives, while also having to use condoms, as the pill by itself hasn’t proven to be wholly effective.
Then there is the issue of funding. Already, HIV medications are expensive for the taxpayer and are difficult to get for the people who really need them, PLWHA.
I’m not pulling any punches by saying that I’m incredibly dissappointed with both AFAO and NAPWA for supporting such irresponsible dispensing of toxic and expensive medications for such frivolous usage. I’m completely disgusted in their attitude.
We already have a way of preventing HIV transmission in this country. Condoms, non-insertive sex, regular testing and PEP if all else fails.
Of course the other thing that hasn’t been mentioned has been that this pill will not stop the spread of other STIs.
Totally agree
As far as I’m aware there is no difficulty for an HIV positive person to receive antiretroviral (ARVs) drugs in Australia. Indeed there is a national awareness strategy to encourage people who are not on ARVs currently to commence taking them.
Linking AVRs to resistant antibiotics is flawed science.
That HIV infection rates are reduced in this country does not mean new infections have been eliminated. Far from it.
The need for PEP seems to counter the idea that there are fail proof ways of preventing exposure to HIV.
And testing is not a form of prevention.
Using emotively laden arguments such as these implies that a person who acquires HIV has done so with some form of irresponsible act. Not necessarily so!
PreP does not have to be used for the rest of a person’s life, and linking it to problems with condom use and STIs is flawed logic.
I fail to see how supporting another tool in the fight against HIV should be disappointing or disgusting. Another way of HIV prevention is not frivolous.