Pre-Exposure Prophylaxis or PrEP

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. This blog looks at some of the pros and cons of PrEP.

Tuesday, April 19, 2011

AIDS Healthcare Foundation Are Right to be Cautious

The AIDS Healthcare Foundation (AHF) are a good friend to Western gays but Western men who have sex with men (MSM) seem to think otherwise. Gilead's Truvada, was found to be 44% effective in preventing HIV transmission in MSM in the iPrEx trials. This result means that the drug would be of marginal benefit, at best, outside of trial conditions. At worst, HIV transmission rates could stay the same or increase.

All AHF are saying is that FDA (US Food and Drug Administration) approval for use of Truvada as pre-exposure prophylaxis should be delayed until it is fully understood why effectiveness is so low and what sort of value this use of the drug has, if any. Do Western MSM wish to be guinea pigs in what would merely be a re-run of the trials but under less favorable conditions?

The FEM-PrEP trial of Truvada as pre-exposure prophylaxis for women engaging in (presumably vaginal) sex with men showed no effectiveness whatsoever in reducing HIV transmission. Most of the study participants were women in African countries, and perhaps Western MSM are not so worried about this group. But AHF are drawing attention to the fact that it is far too early to give the drug approval. They are not saying it should never get approval.

In areas where HIV transmission is phenomenally high, such as in the study areas, entire sectors of the female population are being infected. And even after these supposedly controlled trials, research doesn't appear to have shown why women are being infected in such large numbers, especially when their sexual behavior is similar to that of women in low prevalence countries and the men they are having sex with are far less likely to be infected.

If you don't know how people are being infected, throwing drugs at them will not solve the problem. Gilead may be able to increase their profits by a billion or more, but the HIV industry wasn't established to make wealthy and powerful pharmaceutical companies wealthier and more powerful. If and when PrEP is able to show its value in reducing HIV infection, it should be considered for approval. But it has not yet shown its value and the HIV industry should distinguish between who is suffering from the effects of AIDS and who is profiting from it.

[For further comments about PrEP, see my other blog.]


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