Pills before and after sex can help prevent HIV, study finds

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Pills before and after sex can help prevent HIV, study finds
By MARILYNN MARCHIONE

SEATTLE (AP) — For the first time, a study shows that a drug used to treat HIV infection also can help prevent it when taken before and after risky sex by gay men.

The results offer hope of a more appealing way to help prevent the disease beyond taking daily pills and using condoms, although those methods are still considered best.

The study, done in France and Canada, is the first to test "on demand" use of Truvada, a pill combining two AIDS drugs, by people planning to have risky sex. The uninfected men who took it were 86 percent less likely to get HIV compared to men given dummy pills.

"That impressed me," Dr. Scott Hammer said of the size of the benefit. He is an AIDS specialist at Columbia University in New York and heads the Retrovirus Conference going on in Seattle, where the results were discussed Tuesday.

Daily Truvada pills are used now to prevent HIV infection in people at high risk for it, and studies show the drug helps even when some doses are skipped. Health officials have been leery of billing it as a "chemical condom" out of fear that people will not use the best prevention methods, but many won't use condoms all the time or take daily pills.

The study of Gilead Science's Truvada was led by the French national HIV research agency.

Men were given fake or real Truvada and told to take two pills from two to 24 hours before sex, a third pill 24 hours later, and a fourth pill 48 hours after the first dose. The men also were given condoms and disease prevention counseling.

The study was stopped early, in November, after 400 men were enrolled and researchers saw that the drug was working; there were two new HIV infections among those on Truvada and 14 in those on dummy pills. The two infections in the Truvada group were in men who stopped using the pills after more than a year in the study.

The drug was safe, but nausea and diarrhea were more frequent among men who used it. Only one stopped using it because of side effects.

Dr. Susan Buchbinder, an AIDS specialist at the San Francisco Department of Public Health, called the results exciting but warned that it can't be assumed they would apply to male-female sex, because different types of sex expose partners to differing amounts of virus.

The U.S. Centers for Disease Control and Prevention still recommends daily Truvada pills for prevention, and many men in the French study ended up taking them nearly that often because of how frequently they had sex, said the CDC's HIV prevention chief, Dr. Jonathan Mermin.

"We need all the options we can get" for preventing HIV infection, Mermin said. "People choose different prevention methods. What we want is for them to choose effective ones and to use them regularly."

One advocate for wider use of prevention pills — Damon Jacobs, a New York City psychotherapist — agreed.

For years, the public health message was "condoms only, condoms only, condoms only," he said in a speech at the conference. "People are having sex for pleasure" and need alternate ways to reduce their risk, Jacobs said.

A second study presented at the conference by the U.K. Medical Research Council found that daily use of Truvada cut the risk of infection by 86 percent in a "real world" test of gay men aware they were taking Truvada for HIV prevention.

Researchers assigned 545 gay men to get Truvada right away or a year later. The study was stopped in October after HIV infections occurred in only three men given Truvada but in 19 of those assigned to get it after a year.

As in the French study, rates of other sexually spread diseases were similar in both groups, leading researchers to conclude that use of the prevention pills was not increasing risky behavior.


-- (c) Associated Press 2015-02-25

[Emster23]

How about practicing safe sex to begin with? Seems a no brainer. Easier to keep nasty virus out than deal with it inside of one's body. Behavior change seems more sensible than dosing the body... 86% success means 14% failure?

[BigBadGeordie]

I will await confirmation from a Thai hospital berfore I believe this story, I am sure some of the foreigners just make things up to inflate their ego.

[ronthai]

Idiots, all of them. Running drug tests which include unsafe sex.

[Seastallion]

Idiots, all of them. Running drug tests which include unsafe sex.

Yeah I was a bit shocked at the ethics seeming to say, "Go forth and multiply (the virus)".

But then I realised, the men in the study would do whatever they were doing whether they were in the study or not, so there was no increase in risk for them. They were also counselled about safe sex being the best option. The study made some very good observations and seemingly prevented most of the participants from contracting the disease.

[peridot]

Taking Truvada as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are both very effective. This was the biggest news at the 2014 international AIDS conference. In the PARTNERS study, a very large study of Truvada use, found no transmission among people who took it at least 4 times per week. No transmission, zero. There is still a theoretical risk, but no actual transmissions in that study. I this study, the OP says "The two infections in the Truvada group were in men who stopped using the pills after more than a year in the study". The people who contracted HIV had stopped taking the Truvada, so they were no longer protected.

This is not unsafe sex. This is another option for safe sex. It is actually less risky than using condoms, which the US CDC says have a 12% failure rate.

The other major study presented at the 2014 AIDS conference was that people who have HIV who are taking medicine and have no dectable viral load (measurable HIV in the blood) do not pass HIV. This study found zero transmissions of HIV from people who take their pills regularly so they have surpassed the HIV virus in their bodies.

The people who are spreading HIV now are the people who don't know they have it. Without medicine, the virus is much easier to transmit to others. With medicine, it is very difficult. Those with the highest viral loads are the recently infected. This calls for more testing, and immediate treatment upon HIV diagnosis. In Thailand, most doctors wait until there are signs of immune system depression before they start treatment. Earlier treatment would decrease the spread of HIV. Treatment is prevention.

[bushwacker]

Seems like a huge ethics problem to me. .... "here take these pills before and after unsafe sex". Hehehehehe ... they are just candy!

[smedly]

Taking Truvada as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are both very effective. This was the biggest news at the 2014 international AIDS conference. In the PARTNERS study, a very large study of Truvada use, found no transmission among people who took it at least 4 times per week. No transmission, zero. There is still a theoretical risk, but no actual transmissions in that study. I this study, the OP says "The two infections in the Truvada group were in men who stopped using the pills after more than a year in the study". The people who contracted HIV had stopped taking the Truvada, so they were no longer protected.

This is not unsafe sex. This is another option for safe sex. It is actually less risky than using condoms, which the US CDC says have a 12% failure rate.

The other major study presented at the 2014 AIDS conference was that people who have HIV who are taking medicine and have no dectable viral load (measurable HIV in the blood) do not pass HIV. This study found zero transmissions of HIV from people who take their pills regularly so they have surpassed the HIV virus in their bodies.

The people who are spreading HIV now are the people who don't know they have it. Without medicine, the virus is much easier to transmit to others. With medicine, it is very difficult. Those with the highest viral loads are the recently infected. This calls for more testing, and immediate treatment upon HIV diagnosis. In Thailand, most doctors wait until there are signs of immune system depression before they start treatment. Earlier treatment would decrease the spread of HIV. Treatment is prevention.

Good post and correct, something everyone should be aware of

Those infected and under effective treatment cannot pass on HIV - (read that last year on the BBC News)

Those that engage in risky behaviour (unprotected sex) and do not get routine tests done are highly irresponsible to themselves and their future sexual partners who may know nothing of their past risky activity. These are the people who are spreading HIV infecting others - IMO not knowing if you are infected or not is no excuse

Ultimately it is still the responsibility of each of us to take precautions and protect ourselves - the OP describes an option that seems very effective regardless of condom use

[Dogmatix]

South African males will continue to believe that having sex with a white virgin is the only effective cure for HIV. My niece there is extremely wary of this belief.

[BigBadGeordie]

South African males will continue to believe that having sex with a white virgin is the only effective cure for HIV. My niece there is extremely wary of this belief.

Ah but if she eats beetroot?

[Xircal]

Taking Truvada as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are both very effective. This was the biggest news at the 2014 international AIDS conference. In the PARTNERS study, a very large study of Truvada use, found no transmission among people who took it at least 4 times per week. No transmission, zero. There is still a theoretical risk, but no actual transmissions in that study. I this study, the OP says "The two infections in the Truvada group were in men who stopped using the pills after more than a year in the study". The people who contracted HIV had stopped taking the Truvada, so they were no longer protected.

This is not unsafe sex. This is another option for safe sex. It is actually less risky than using condoms, which the US CDC says have a 12% failure rate.

The other major study presented at the 2014 AIDS conference was that people who have HIV who are taking medicine and have no dectable viral load (measurable HIV in the blood) do not pass HIV. This study found zero transmissions of HIV from people who take their pills regularly so they have surpassed the HIV virus in their bodies.

The people who are spreading HIV now are the people who don't know they have it. Without medicine, the virus is much easier to transmit to others. With medicine, it is very difficult. Those with the highest viral loads are the recently infected. This calls for more testing, and immediate treatment upon HIV diagnosis. In Thailand, most doctors wait until there are signs of immune system depression before they start treatment. Earlier treatment would decrease the spread of HIV. Treatment is prevention.

I wouldn't recommend anyone take drugs for something that they don't have. Most heavyweight medication has side effects and in the case of Truvada, not very pleasant ones: https://en.wikipedia.org/wiki/Tenofovir/emtricitabine#Adverse_Reactions

Truvada is also not going to alleviate other more common infections such as NSU and the safest way to avoid any of them is to use a condom.

That said, if you get to know someone long term and you both take an HIV test, then it should be reasonably safe to have unprotected sex.

Edited February 26, 2015 by Xircal