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AIDS Drugs Proven as Prevention Tool

   Joe DeCapua 23 November 2010

   A  new  study  shows that anti-retroviral drugs can be used to prevent
   HIV   infection   in  uninfected  people.   Itâs  called  PrEP  â  or
   pre-exposure prophylaxis.

   The  findings,  released Tuesday, appear in the New England Journal of
   Medicine.   Researchers say it could âfundamentally change strategies
   to slow the global HIV epidemic.â

   The  iPrEx  study  was  sponsored  by  the U.S. National Institutes of
   Health through a grant from the non-profit Gladstone Institutes, which
   are affiliated with the University of California at San Francisco.

   Take a pill

   Mitchell  Warren,  head  of the AIDS Vaccine Advocacy Coalition in New
   York,  has  been  following  the  iPrEx study.  He says, âThe idea of
   pre-exposure  prophylaxis  is  basically  to take a pill in advance of
   exposure.  And this is not unique to HIV.  Travelers do this all the
   time with malaria prophylaxis.â

   PrEP  has been receiving more attention over the last five years among
   AIDS researchers.

   âThe  anti-retroviral pill â the same one that treats many people with
   HIV â might actually have a preventive effect,â he says.

   The  iPrEx  study  is  the first of several studies on the efficacy of
   PrEP.

   Warren says, âThis is the first one at all representing results.  And
   the results are very, very positive and very exciting.  They are very
   specific.  This trial took place among men and transgender women, who
   have sex with men in six countries around the world.â

   The  study was conducted at 11 sites in South Africa, Brazil, Ecuador,
   Peru,  Thailand  and  the United States.  The drugs used in the study
   were a combination of tenofovir and emtricitabine.

   Fundamentally change HIV strategies

   âWe  know we have incredibly powerful prevention options already, most
   importantly  the  male  and female condoms.  Those donât change.  We
   need those products,â he says.

   But  warren  adds,  âWe  now have a back-up, an additional tool.  And
   itâs important to recognize that in the trial itâs not just saying the
   pill  worked.   The pill provided 44-percent additional protection on
   top  of  the  standard, state of the art prevention services that were
   being provided in the trial.â

   He  says  this  is  important news for those who have little choice in
   saying whether a condom will be used during sex.

   Simple, butâ¦

   Taking  a pill appears simple enough, but apparently not simple enough
   for everyone.

   âThe  good news is for those participants who did take their pill on a
   regular,  consistent  basis,  they  seemed  to  have  higher levels of
   protection.   The  challenging news though is that there werenât that
   many people who were able to adhere to that regimen,â he says.

   He  says  more research should be done on the effectiveness of PrEP if
   the pill is not taken on a regular basis.

   âIs  it more feasible and more acceptable to people, but does it still
   provide protection.  And that doesnât get answered in this study,â he
   says.

   The  drugs  are powerful and can have side effects.  Thatâs something
   that  should  be  kept  in  mind  before  attempting  to use them as a
   prevention  method.   However,  another problem was also uncovered in
   the study.

   âThere were two cases of resistant HIV that seemed to have been caused
   by people taking PrEP when they were already infected, but didnât know
   it.  So  it really highlights that for Prep to be effective youâve got
   to  have  confirmed HIV negative status before you start taking PrEP,â
   he says.

   Nearly  2500  individuals  took part in the study.  Tenofovir, one of
   the  drugs  used in the study, was also an ingredient in the promising
   microbicide  CAPRISA  004,  which received much attention earlier this
   year.

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