A pretty big deal: A daily pill to prevent HIV infection

Anti-HIV drug Truvada
NIH

Medical researchers have shown that taking a common anti-AIDS drug can be used to prevent HIV infection in sexually active men by more than 70 percent — or even up to 95 percent if taken with complete diligence.

This could be a pretty big deal.

As a new UN report states, we are making progress against HIV/AIDS worldwide but too many (nearly 2 million people) are still getting infected every year.

Just how big a deal this study of an anti-HIV daily pill could turn out to be may escape the public’s attention, some say, due to the typical caveats and qualifiers that often accompany the announcement of scientific study results. Not to mention this being the start of the holiday season.

So some pundits, like Andrew Sullivan at The Daily Dish, are trying to make sure these study results get the attention deserved. Sullivan entitled his post “A Massive HIV Breakthrough.” Says Sullivan:

“It’s the first drug that, if taken by HIV-negative men, has now been proven to help prevent HIV infection …. This is the best news in a very long time – alongside the recently developed vaginal microbicide – because it empowers people to protect themselves in ways that do not involve any action before or during sex, when one’s judgment is most impaired.”

The study of this drug, actually a combination of drugs known as Truvada, was published in Tuesday’s New England Journal of Medicine and was funded by the NIH and the Bill & Melinda Gates Foundation. Researchers at UC-San Francisco led the study, which involved 2,500 gay and bisexual men in six countries as was described here in the SF Chronicle.

Sullivan wasn’t alone in calling this a breakthrough development in HIV prevention research. That word, typically avoided by many science journalists because of its hyperbolic (and usually unjustified) implications, was used by many, if not most, news reports on this study. The Obama Administration even weighed in with a word of congrats, though choosing to say “groundbreaking” rather than breakthrough.

There are still other studies to come testing this strategy, which is generally known as pre-exposure prophylaxis (or PrEP in the parlance of the research community). If they, as expected, also show that these drugs can significantly reduce HIV infection, other difficult issues will have to be addressed:

As NPR’s April Fulton noted this “breakthrough” comes with a price:

A treatment that’s being billed as a big breakthrough in AIDS is prompting a very uncomfortable question: How much are we willing to pay to prevent people from becoming infected with HIV?

NBC’s Robert Bazell ponders some of the unintended consequences of “medicalizing” HIV prevention:

But as further research is being planned among other groups – women, and intravenous drug users, for example — questions remain about how best to use Truvada, a combination of antiretrovirals sold in a single pill, that could help prevent the spread of AIDS worldwide.

And the BBC’s Fergus Walsh (who avoids using the word ‘breakthrough’) emphasizes the significant questions and hurdles that remain:

There are many issues to resolve. The trial involved gay men and no studies have been done to show whether it would reduce heterosexual transmission. The medication was not without side-effects, including nausea. It is also expensive – costing between $5,000-$14,000 in the United States. There are also concerns that it might allow HIV-resistant strains to develop.

There have been a number of significant advances on the HIV prevention front in the last year or two, such as the recent study in South Africa that showed women could prevent HIV infection using a vaginal microbicide and a vaccine study in Thailand done last year that showed, for the first time ever, modest protection against HIV.

Progress is being made, but it’s no small feat to move from the laboratory to practical reality.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.