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ScienceNOW published an encouraging update this afternoon on the results of two pre-exposure prophylaxis (PrEP) trials in sub-Saharan Africa. To quote the opening paragraph of the report:

It's a bad day for the AIDS virus. Results from two studies in sub-Saharan Africa, simultaneously announced today, show for the first time that daily doses of anti-HIV pills taken by uninfected men and women can prevent heterosexual transmission of the virus. Widely hailed as a "breakthrough" in HIV prevention by public health officials, the studies—one of which dropped its placebo arm today because of the convincing effects of the intervention—add powerful new tools to derail transmission of the virus in the population that accounts for most of the 34 million infections in the world.

For those of you not familiar with the way clinical research is done, most studies are "double-blind"--meaning that neither the researchers nor the test subjects know whether the subjects are receiving the trial compound or a placebo. This is done to prevent attempts to "steer" the results in one direction or the other. However, on most trials that involve catastrophic or deadly illnesses, an independent oversight board will sneak peeks behind the veil of ignorance (to steal a term from John Rawls) to monitor progress of the study. If that review board finds that the proposed treatment or intervention has either no effect at all in comparison to the placebo, a deleterious or a harmful effect, or a significant beneficial effect, it will either halt the study outright (in the first two cases) or, as happened here, recommend dropping the placebo arm and giving everyone in the study the proposed treatment.

The news isn't perfectly rosy, however. The good news is that antiretroviral drugs given before actual exposure significantly reduce the risk of subsequent infection (all other things being equal). The bad news is, antiretrovirals are expensive, and may have side effects (particularly after long-term use). As the Science staff noted:

Aside from altering the design of clinical trials, the new data raise difficult financial questions. Truvada now is licensed only as an HIV treatment. If regulators change the drug's label to indicate that it works as a preventive, this could prove critical to whether insurers and governments will pay for Truvada PrEP, which at a discounted rate still costs more than $100 a year when used daily. But the world cannot now afford to treat all the already-infected people who need antiretrovirals, raising the dilemma of where scarce funds should go, to prevention or treatment. Further complicating matters, treatment makes infected people less infectious and is a form of prevention itself; next week, the World Health Organization is expected to recommend that all infected people in discordant couples receive ARVs—a huge challenge for many resource-limited countries.

On balance, though, I think this is a development worth celebrating.

Originally posted to musing85 on Wed Jul 13, 2011 at 04:37 PM PDT.

Also republished by HIV AIDS Action.

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Comment Preferences

  •  This is good news (3+ / 0-)
    Recommended by:
    musing85, Dallasdoc, rmx2630

    the account in the NYT also stated that an earlier study with similarly encouraging results involved gay men.  This is the first study showing protection in heterosexuals, by far the largest group of AIDS sufferers.

    I used to be Snow White...but I drifted.

    by john07801 on Wed Jul 13, 2011 at 05:16:10 PM PDT

  •  Republished to HIV/AIDS Action (3+ / 0-)
    Recommended by:
    liberaldemdave, musing85, Dallasdoc

    Thanks for this bit of good news.  Good news is a bit rare on the HIV front, so it's nice to have something to celebrate, even if it comes with caveats.

    I suspect that the cost is going to be a dealbreaker for PrEP.  I can't imagine either insurance companies or governments being willing to foot the bill so that healthy people can take very expensive drugs to keep them from getting a virus that (it will be argued) can easily be avoided through condom use.  Here in the U.S., I think it's pretty much inconceivable that there will be much appetite for something like this.  After all, it will simply be cast as "encouraging" promiscuous sexual behavior.

    "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

    by FogCityJohn on Wed Jul 13, 2011 at 06:02:52 PM PDT

    •  There's not much hope of sanity (2+ / 0-)
      Recommended by:
      FogCityJohn, Dallasdoc

      from this government on anything to do with sex or sexually transmitted diseases. Other governments may be sane, but they lack the resources needed to make this feasible. And somehow, I tend to doubt that the drug companies are going to develop consciences and either cut their prices or start providing more drugs for free.

      A really good argument for making healthcare a not-for-profit industry.

  •  what it doesn't mean... (2+ / 0-)
    Recommended by:
    Dallasdoc, snoopydawg

    something will save you if you choose to practice higher risk sex.

    old enough to recall how many folks figured Magic Johnson looked so freakin' hot good in the GlaxoSmithKline ads that barebacking was possible again, and issues could be 'fixed.'

    my friends with HIV consider it a manageable condition, but still one they don't really wish on anyone.

    meanwhile, y'all of course know it will cost more in this country than overseas (um, we pay down the cost in poorer countries every time.) so even if it's approved here, be prepared to shell out.

    •  Thanks kravitz (0+ / 0-)

      My brother died in 92 and I lived thru the times of the funerals, tears and holes in people's lives.
      I am disgusted that the infection rate is still so high. All the fighting we did back then seems to be in vain when people still expose themselves to risks.
      We got good drugs but you are right. It is an acceptable, controllable disease today. Really pisses me off.

      Why are we still paying for Congress's health insurance, their meals and all the other perks they get while they are gutting ours? They get all the perks while we get a pile of shit.

      by snoopydawg on Wed Jul 13, 2011 at 09:05:53 PM PDT

      [ Parent ]

      •  Progress shouldn't piss you off. (1+ / 0-)
        Recommended by:
        musing85

        I live with HIV, and I'm thankful it's a manageable disease.  

        You should also remember that all kinds of people expose themselves to all kinds of risks every day.  Are you pissed at them?  It's dangerous to get behind the wheel of a car, but somehow I don't see a lot of indignation at people who continue to drive despite all the risks.  

        I don't know if you recognize how much homophobia is behind all of these denunciations of gay men who "take risks."  All people take risks (witness straight folks and their "unplanned" pregnancies, for example), but we don't make the same kinds of value judgments about them.  We reserve those for gay men, because they're engaging in behavior that society thinks shouldn't be going on at all -- they're having sex.

        "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

        by FogCityJohn on Thu Jul 14, 2011 at 08:32:33 AM PDT

        [ Parent ]

        •  it isn't homophobia (0+ / 0-)

          that excuse of homophobia being behind the idea of risk has long been disproved.

          there are reasons that involve self esteem. there are reasons that involve self love. there are reasons that include how some are open to the experience of life on a spiritual level.

          self esteem. in need of human interaction of any kind.

          self love. willing to share.

          spiritual. whatever happens is destiny.

          there's nothing about gender identity in any of it besides they type of sex the given individual wants to have.

          as a reminder, the test was done with gay men first. this second test was heterosexuals. so clearly, the issues are universal.

          •  You misunderstood my point (0+ / 0-)

            The prior comment expressed anger at people who took risks by (presumably) having unprotected sex.  What I am pointing out is that all kinds of people engage in all kinds of risky behavior all the time, some of which results in them getting ill, injured, or killed.  Yet we don't get angry at all people who engage in risky behavior.  As I explained, we don't get angry at people for getting injured while driving, even though we know to a statistical certainty that a certain number of people will be killed or injured in automobile accidents.  (And these injuries or deaths can occur even if the victim exercises all possible care.)

            Homophobia enters the picture because many people get angry at gay men and judge them harshly for their risk behavior.  Those same people don't get angry at drivers, mountain climbers, scuba divers, or surfers when they get injured because they engaged in risky behavior.  In other words, the value judgment is based not on the fact that someone took a risk, but rather on the behavior in which the person engaged.  When that behavior is gay male sex, people get "angry."  When it's something that heterosexuals engage in, not so much.

            "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

            by FogCityJohn on Thu Jul 14, 2011 at 04:15:52 PM PDT

            [ Parent ]

            •  the last line (1+ / 0-)
              Recommended by:
              FogCityJohn

              agreed.

              unless it's black kids and unwanted pregnancies, that is. but that's not the topic.

              thanks 4 le clarificacionne!!!

              •  Exactly (0+ / 0-)

                But that's just another instance of prejudice dictating what kind of risk behavior we find acceptable and what kind we don't.

                "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

                by FogCityJohn on Fri Jul 15, 2011 at 01:22:46 PM PDT

                [ Parent ]

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