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.

Saturday, August 27, 2011

Don't Get Stuck with HIV: Medical and Cosmetic HIV Transmission

Anyone truly concerned about preventing HIV might wish to know more about non-sexually transmitted HIV, which is a lot more common than UNAIDS and the HIV industry would like us to believe.

The purpose of this new website, "Don't Get Stuck with HIV", is to help people protect themselves from from infection during medical and cosmetic procedures, such as getting an injection, having one’s head shaved, getting a tattoo or pedicure, or going to the dentist. Check through the A-Z of site content to see if you might be taking any risks!

If you have any comments don’t hesitate to get in touch. There is a comment form on every page. We will try to get back to you, and we will consider every comment, but we can’t promise to comply with every request!

Also, you can sign up to receive updates, as and when they appear, by using the email subscription ‘Sign me up!’ button on the right hand column of every page.


Wednesday, August 17, 2011

Can HIV Drugs Replace Human Rights?

Here's another interesting post about PrEP from Joseph Sonnabend's blog. In addition to the iPrEx trial showing a very small absolute risk reduction for Truvada, the cost of preventing one HIV infection is also massive. Sonnabend's estimate is about half a million dollars.

Even at a fraction of that cost, it seems unlikely that any high HIV prevalence country could afford PrEP. Nor are any donors likely to be in a hurry to finance a large PrEP program.

But there are a couple of other worries expressed: PrEP will only be appropriate for a small number of people, and they are mostly living in rich countries. And HIV prevention as a whole is in danger of being thrown off course by the euphoria about PrEP. Money which should be going to education could be diverted to drugs which are expensive and of very limited use.

People still need to be aware of the risks of being infected with HIV and of what they can do to avoid it. Spending all prevention funds on PrEP will not have the impact being claimed by the HIV drug industry.

Here in East Africa, there has been so much discussion about people's rights over the years, how those rights have been denied and how this relates to HIV transmission. Are their rights now so worthless that they can be replaced with some overpriced drugs that don't even work very well?


Tuesday, August 9, 2011

Vital Distinction Between Absolute and Relative Risk Reduction

In order to understand how misleading all the jubilation about recent PrEP trials is, have a look at one of Joseph Sonnabend's two blogs. He explains the difference between relative risk reduction, which is the widely reported finding from the trials, and absolute risk reduction, which is the very low figure that doesn't seem to have been reported at all.

The first blog launches straight into explanations of the two risk figures and an account of why the difference matters so much. But either blog will demonstrate how the whole PrEP issue has been blown up into a 'game changer', in the words of the HIV industry.

Sonnabend shows that the absolute risk reduction is only 2.3%, a far cry from the 44% relative risk reduction reported, which doesn't really give you any way of evaluating the trial results. He also points out that 45 people need to be treated with Truvada to prevent one HIV infection.

There are over 40 million people in Tanzania and only a few hundred thousand of them currently receive antiretroviral drugs, out of well over one million HIV positive people. If PrEP just involved drugs it might be possible to work out the exorbitant amounts of money required, but drugs are only part of it.

It's time for a bit of honesty in reporting figures when it comes to drug trials. There are millions of HIV positive people and tens of millions of people who may be at risk. They deserve the truth.


Tuesday, August 2, 2011

Why PrEP When Condoms and PEP Would do the Job Better?

I'm still a little puzzled as to why PrEP is considered to be such a great idea, except by the pharmaceutical industry, of course. PrEP is nowhere near effective enough for people to depend on it; they will need to use condoms as well. So why go to such effort and expense? The chances of a condom bursting are very small and if it happens, people can use post-exposure prophylaxis (PEP).

The difference in cost is obvious. PEP would also reduce the likelihood of resistance developing and remove the need for long term adherence. And the side-effects which the pharmaceutical industry don't like to allude to, especially the long term side-effects, will be irrelevant except for the duration of treatment.

[For more about HIV and risk, see my other blog, HIVinKenya]


Monday, August 1, 2011

UNAIDS: Everyone in Africa is at Risk of HIV; so PrEP is Useless?

I've found an uncharacteristically sensible article on PrEP, although it's written from a US perspective. It concludes that "Findings from the randomized clinical trials that PrEP is efficacious should mark the beginning of the policy discussion, not its end."

The article also demands proof of desirability and even deliverability of PrEP before the strategy is implemented. The authors note that sustained and effective counseling is a must to ensure proper adherence to the drugs and that the level of counseling required, which makes up a major part of clinical trials, is unlikely to be part of a community implementation.

Also noted are the lengths that researchers had to go to in order to retain participants in the iPrEx trial, an aspect of such trials that is rarely mentioned when reports of standing ovations at expensive pharmaceutical sponsored conferences come out. The odds during the iPrEx trial seemed to have been stacked against getting a poor result. And yet the result was pretty unimpressive.

The article covers a lot of interesting aspects of PrEP that are rarely mentioned among the post trial hype, such as development of resistance to antiretroviral drugs, increased 'unsafe' sexual behavior among some who think PrEP will give them 100% protection and the sheer cost of such a program that provides drugs for uninfected people when there isn't even enough funding for those who are infected.

But the article, perhaps being written from a rich country perspective, doesn't mention how spectacularly unsuccessful we have been in identifying 'core transmitters' of HIV in developing countries. In fact, any group that could be considered to be contributing significantly to HIV epidemics in high prevalence African countries is dwarfed by the percentage of infections that are said to come from 'low risk' groups.

In short,if PrEP ever proved itself to be feasible in high prevalence African countries, we wouldn't have the faintest idea where to start.

[For more about HIV and risk, see my other blog, HIVinKenya]