Study finds that daily antiretroviral dose lowers HIV infection risk

[Jingthing]

This is amazing news about HIV prevention. A new approach that so far appears to work remarkably well.

This is for high risk individuals and uses DAILY MEDICATION.

Daily drug lowers AIDS risk, study says

By David Brown

Washington Post Staff Writer

Tuesday, November 23, 2010; 9:16 AM

When gay men at high risk of becoming infected with HIV through sex take a daily dose of antiretroviral drugs, their chance of catching the virus drops by at least 40 percent, according to a new study.

The protective benefit could be as high as 95 percent if a person is extremely attentive about not missing a dose, the research on nearly 2,500 men on four continents found.

The study was with gay men but presumably any high risk group could benefit.

The wrinkle for Thailand is this --

The two drugs in the study - emtricitabine and tenofovir - aren't officially approved for AIDS prevention. However, doctors can prescribe them for that "off-label" purpose. Sold in combination under the brand name Truvada, they cost between $5,000 and $14,000 a year, depending on whether they are bought at retail price or with a bulk discount. In generic form sold to the poorest countries, however, the combination costs as little as $150 per year.

http://www.washingtonpost.com/wp-dyn/content/article/2010/11/23/AR2010112302609.html

Now a question our medical expert here. How much would this protocol cost for an expat who wanted to go on this therapy in Thailand, buying the meds retail? I assume the really low price is some kind of government program that most expats wouldn't be covered on? Are these meds available over the counter in Thailand?

Another question, why shouldn't every high risk person in Thailand start this protocol ASAP? (Sexually active gay men, male and female prostitutes, etc.)?

Edited November 23, 2010 by Jingthing

[News_Editor]

Study finds that daily antiretroviral dose lowers HIV infection risk

2010-11-24 02:33:27 GMT+7 (ICT)

WALTHAM, MASSACHUSETTS (BNO NEWS) -- The New England Journal of Medicine on Tuesday released a study that found that a daily dose of an antiretroviral significantly lowers the risk of HIV infection.

The multinational study was called the Preexposure Prophylaxis Initiative (iPrEx) trial. It was aimed to evaluate the safety and efficacy on the prevention of HIV acquisition among men and trans-gender women who have sex with men.

The antiretroviral tested was a preexposure chemoprophylaxis, which is recommended after occupational or nonoccupational exposure to HIV-infected fluids. Investigators combined emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) into a single tablet (FTC-TDF).

The study found that a daily dose of FTC-TDF taken by HIV-negative gay and bisexual men reduced the risk of HIV infection by 43.8 percent. The antiretroviral had higher rates of effectiveness, up to 73 percent, among those individuals to followed the regime closer.

"I am encouraged by this announcement of groundbreaking research on HIV prevention. While more work is needed, these kinds of studies could mark the beginning of a new era in HIV prevention," said U.S. President Barack Obama.

Investigators tested 4,905 individuals from July 2007 to December 2009 at 11 sites in six countries. All subjects were born male although 29 people listed their current gender as female. The ages of the subjects ranged from 18 to 67 years.

To best compare results, investigators tested one group with the FTC-TDF tablet and the other group with a placebo tablet. The study was coordinated by the Gladstone Institutes of the University of California in San Francisco.

The Preexposure Prophylaxis protection (or PreP) is the first new form available for men. It is especially designed for individuals who cannot use condoms because they prostitute themselves, are in danger of prison rape, under pressure from partners or lose inhibitions due to alcohol or drugs.

Last summer, an effective microbicide gel was introduced as the newest and most effective form to prevent female HIV infection. Despite results, no HIV prevention method is 100 percent effective but a combination of approaches are necessary ton reduce risk of infection.

The iPrEx trial study was paid by the National Institutes of Health and the Bill and Melinda Gates Foundation.

-- © BNO News All rights reserved 2010-11-24

[Sheryl]

2 similiar threads merged.

Antiretroviral drugs are prescription only in Thailand.

These study results have only just been released and it will be some months at least before health officials in various countries establish relevant guidelines.

Note that

(1) the drugs do not altogether prevent HIV infection, just reduce the risk;

(2) the drugs in addition to being expensive are highly toxic, such that the benefit if taking them would outweigh the risks only in individuals at exceptionally high risk of HIV infection; and

(3) in addition to more serious toxicities, the drugs have unpleasant side effects, especially early in use, which is likely to affect compliance. Unfortunately, people who do not use condoms regulalry are also, as a group, less likely to comply with a difficult and unpleasant prophylactic medication regimen. Which is not to say that there are not individuals for whom it would be suitable, but perhaps fewer than one might hope. Most people who are sufficiently knowledgeable and concerned about HIV risk to take medication regularly for life would also be likely to regularly use condoms, making the former unnecessary.

Lastly the development of strains of HIV resistant to these medications is a serious concern and one that will be factored into policy recommendations.

[GoodKarma]

Antivirals for perfectly healthy people?

Speechless.

[JAS21]

Antivirals for perfectly healthy people?

Speechless.

Have you guys ever thought about finding yourself a nice, well educated middle aged Thai lady. Make a wonderful wife and not much chance of getting HIV etc. After nine years I can highly recommend it.

[Jingthing]

Sheryl is our medical expert here, but I have reservations about her comments. First of all, do we know the DOSES they used in this study? Without knowing the dosage, how can we know much about the degree of toxicity of the side effects? If the side effects are indeed severe, that would explain at least partly the lack of full compliance in daily dosing in the test group. Also, unlike Sheryl, I don't have full confidence in condoms. So often they aren't stored properly, they aren't put on properly, they aren't used properly, they don't fit properly, not to mention actual breakage. For sexual active people with unknown multiple partners (yes especially homosexuals, and even more so especially passive homosexuals) of course condoms are a necessity, but as the study clearly states, MULTIPLE preventative measures are much better and statistically (at least so far) MUCH more protective. As I asked before, the difference in cost between the west and here is very interesting. Does anyone know what the cost would be in Thailand if prescribed this protocol, especially for a foreigner paying retail? Of course you would have to know the dosage so maybe not a reasonable question as yet.

Edited November 24, 2010 by Jingthing

[Jingthing]

Antivirals for perfectly healthy people?

Speechless.

Why speechless? The idea is using these meds for very high risk people only.

[Forethat]

Antivirals for perfectly healthy people?

Speechless.

Why speechless? The idea is using these meds for very high risk people only.

I think speechless sums it up pretty good. The study clearly pinpoints the core issue with HIV (not the virus itself but it's method of transmission) - reason is not a factor when people get horny.

In the study in question, 2499 trial subjects agreed to undergo the therapy. These subjects new that they were in a high risk group of people (they were gay men), and STILL there were 100 sujects who contracted HIV. If that doesn't make you speechless I just dont know.

The biggest issue with the results appear to be the likelyhood of developing resistance to the antivirals.

I read somewhere here on TV that "there will be a cure available in 15 years". Thats is exactly the kind of rubbish posts that makes people lower their guard.

Use a condom and take care of yourself and the ones you love. Thats also a much more eficient method of lowering the risk for HIV infection than antivirals.

[Jingthing]

The study appears to show that condoms in addition to the dosing is MUCH more efficient for people who are at a very high risk of being infected. It's rather illogical to assert that condoms only are more efficient. How could that be, two different classes of preventative measures instead of one? I appreciate it is one study though but if further studies confirm it, this is a big deal. Calling condom use safe sex is a bit of a misnomer. It is safer sex. This daily dosing seems a logical expansion of the well recognized protocol of people who strongly feel they have been exposed to HIV (broken condom, shared blood needle stick, etc.) immediately going on a temporary course of these meds. This is a standard in the west for many years already, though I think not common in Thailand. If people are exposing themselves quite a lot, perhaps they DO need the meds in their system all the time. If anything surprises me about this, it is why they took so long to think of doing this study. Looking to the future, maybe they can develop better meds with less toxic side effects that perform as well as the meds in the study.

Edited November 24, 2010 by Jingthing

[Forethat]

<BR>If people are exposing themselves quite a lot, perhaps they DO need the meds in their system all the time.<BR>

This is probably the bit that makes me (and others, apparently) speechless. Why expose one self a lot?<BR><BR>When I get my hands on this paper I'll look at it, I dont intend paying.<BR><BR><BR>

[Jingthing]

<BR>If people are exposing themselves quite a lot, perhaps they DO need the meds in their system all the time.<BR>

This is probably the bit that makes me (and others, apparently) speechless. Why expose one self a lot?<BR><BR>When I get my hands on this paper I'll look at it, I dont intend paying.<BR><BR><BR>

Sexually active people with many partners, particularly gay men, male and female prostitutes, not to mention but here goes IV drug users. It's a fact of life for many people in Thailand and the world. That's makes people speechless? Did I miss the memo -- are we in Victorian England? Ignoring the drug users for the moment, the conscious ones of these groups are now faithfully using condoms. Is that good enough protection for these groups? That's one question a study like this asks. If you are saying that the sex behavior in itself is immoral even with protection, that's kind of a religious/personal thing, not a medical thing. Another group that may be interested in these developments are HIV negative people in monogamous love relationships with HIV positive people. That kinds of throws water on any "morality" arguments, now doesn't it?

Edited November 24, 2010 by Jingthing

[Forethat]

<BR>If people are exposing themselves quite a lot, perhaps they DO need the meds in their system all the time.<BR>

This is probably the bit that makes me (and others, apparently) speechless. Why expose one self a lot?<BR><BR>When I get my hands on this paper I'll look at it, I dont intend paying.<BR><BR><BR>

Sexually active people with many partners, particularly gay men, male and female prostitutes, not to mention but here goes IV drug users. It's a fact of life for many people in Thailand and the world. That's makes people speechless? Did I miss the memo -- are we in Victorian England? Ignoring the drug users for the moment, the conscious ones of these groups are now faithfully using condoms. Is that good enough protection for these groups? That's one question a study like this asks. If you are saying that the sex behavior in itself is immoral even with protection, that's kind of a religious/personal thing, not a medical thing. Another group that may be interested in these developments are HIV negative people in monogamous love relationships with HIV positive people. That kinds of throws water on any "morality" arguments, now doesn't it?

I am not to sure you're replying to MY post or someone elses.

The most important thing we need to agree on is that consistent and correct use of condoms is the only known working protection against HIV. Period. If you continue to argue that point there's no need to continue the debate. What makes me (and probably others) speechless is the fact that the consistency and correctness of the use of condom is not as high as you would think - even if you're in a group of people where the risk is considered high.

There is research available that shows that people in monogamous relationships where one party was HIV positive aren't using condoms consistently. Old paper, but in my opinion more than valid since it was published in the middle of 90's when the respect for the virus was at its highest level ever. With the current antivirals available and general perception that you can live a normal life for over 20 years even after infection (to some extent true) I doubt this has changed.

http://www.nejm.org/...199412223312513

Ignoring the drug users for the moment, the conscious ones of these groups are now faithfully using condoms.

Research shows that usage of condom peaked in the middle of the 90's and has been dropping ever since. It is currently at a much lower level compared to the 90's. Most countries reports increasing cases of HIV. Another alarming fact is the number of reported chlamydia cases, sometimes used as an indicator of the level of unprotected sex, which is increasing in most western countries. This clearly shows that condom is not being used as often as it should. So maybe it is the unconscious ones we should worry about.

As with most STD's, HIV suffers from a massive under-reporting. This is a problem if the aim is to prevent transmission. In my opinion, what we dont need is another incentive for the unconscious and irresponsible to continue to skip the use of condom. You only have to browse this forum for a couple of minutes to find posters who claim that "there will be a cure available in 15 years".

Edited November 24, 2010 by Forethat

[Jingthing]

The most important thing we need to agree on is that consistent and correct use of condoms is the only known working protection against HIV.

Condoms, yes, of course. It's going to be hard to find people who disagree that condoms are effective prevention of HIV, with the caveat that there are many factors with using condoms that can sometimes go wrong. Why shouldn't scientists find additional ways that help in ADDITION to condoms? There is a lot of evidence that circumcision helps (active males) and the microbicide gel sounds very promising. Yes, I understand that taking powerful meds for prevention is an extreme measure, so perhaps that will never be done widely, even if it is solidly proven to massively reduce infections. I can't understand general resistance though to science looking into additional measures for people to use in addition to condoms.

Edited November 24, 2010 by Jingthing

[Forethat]

I can't understand general resistance though to science looking into additional measures for people to use in addition to condoms.

I haven't noticed anyone resisting research in the area you're mentioning. In my case, the resistance is against the - statistically proven - perceived and false sense of security which has developed over the past decade. In light of this, the study subject to debate does nothing but offer another excuse for acting irresponsibly.

There are a lot of research going on, though funding is the biggest problem. There are fantastic results popping up daily, a couple of days ago new numbers was released for Truvada, but the only way to stop the HIV pandemic is through a vaccine. Until that vaccine has been developed (massive research on various proteins currently going on) we need to stick to condoms.