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Daily pill helps prevent HIV infection among gay men

Fergus Walsh | 18:44 UK time, Tuesday, 23 November 2010

A daily pill to prevent HIV infection would be a significant development. A trial published in the New England Journal of Medicine suggests that an established treatment for HIV infection is also powerful in protecting gay men from catching the virus.

This is not, however, the answer to the nearly 30 year epidemic of HIV and AIDS. Since it is just one trial, many more studies will need to follow. But according to the Terrence Higgins Trust (THT) it is "potentially very significant and could change the HIV landscape in the future".

Some brief facts about the trial: it involved about 2,500 men at high risk of HIV infection in Peru, Ecuador, Brazil South Africa, Thailand and the United States (San Francisco and Boston). At the start of the study they had on average 18 sexual partners, which dropped to 6 by the end.

Half were given a daily pill - Truvada, a combination antiretroviral drug - which interferes with the virus's ability to replicate in cells. The other half were given a placebo - or dummy pill - each day. All were encouraged to use condoms. After a year 36 men taking Truvada had got infected with HIV compared to 64 on the dummy pills.

Many of the men failed to take the pill every day. Among those who took the medication more than 90% of the time, there were 73% fewer infections.

The treatment is known as pre-exposure prophylaxis. Dr Kevin Fenton, AIDS prevention chief at the US Centers for Disease Control and Prevention called it "a major advance". But he said it should never be seen as a first line of defence against HIV: "It's not time for gay and bisexual men to throw out their condoms".

There are many issues to resolve. The trial involved gay men and no studies have been done to show whether it would reduce heterosexual transmission. The medication was not without side-effects, including nausea. It is also expensive - costing between $5,000-$14,000 in the United States. There are also concerns that it might allow HIV-resistant strains to develop.

For the sexually active the long-standing advice to help prevent HIV infection is:

- use condoms consistently and correctly
- get tested to know HIV status and get treatment for other sexually transmitted infections
- reduce drug use and risky sex
- reduce the number of sexual partners

Given that the drug treatment is not a guarantee against infection and that it involves taking a pill every day, who might benefit?

Sir Nick Partridge, Chief Executive of THT, said it may help prevent HIV transmission among those most at risk: "We are nearly 30 years into this epidemic and yet there are still far too many people getting infected. The majority of new infections in the UK are among gay men. This might help men who seem incapable of using condoms and regularly put themselves at risk."

He also pointed out that the average annual cost of treating one person with HIV was between £7-10,000 a year, so it made good economic sense to try to prevent infection.

The news of the trial comes as figures from the United Nations show that new HIV infections and deaths from AIDS-related illnesses are declining.

Last year there were 2.6m new HIV infections worldwide - the main route of transmission being through heterosexual sex - 20% fewer than a decade ago. In 2009, 1.8m died from AIDS-related illnesses, down from 2.1m in 2004.

There are an estimated 33m people living with HIV.

There have been other encouraging developments in the field of HIV in the past 14 months. In September 2009, scientists announced that a vaccine against HIV had protected nearly one in three people from getting infected in a trial Thailand. This is clearly not a high enough success rate, but it is the best news on vaccination to emerge. In July this year research in South Africa showed that a vaginal gel containing an antretroviral nearly cut in half a women's chance of getting HIV from an infected partner.

Comments

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  • 1. At 07:45am on 24 Nov 2010, Megan wrote:

    Anything that can help protect those who choose a promiscuous lifestyle must be advantageous... it's likely that a combination of both following the current advice (condom use, etc.) and taking prophylactic drugs will improve such people's chances of remaining uninfected.

    Trouble is, how many are going to go to the effort - and expense - of following the regime - it appears even those who'd agreed to participate in trials were not meticulous in taking their tablets! As anyone who does need daily medication knows, it's not too hard to establish a routine to ensure that you pop your pills yet if people interested enough to sign up to trials cannot do so, what chance for the average individual who's chosen a lifestyle in which taking this medication is indicated?

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  • 2. At 12:31pm on 24 Nov 2010, jmsresearch wrote:

    Not sure if the people from the Step Trial (HIV vaccine international trial) will maintained the idea that Circumcision rates, race/ethnicity, age, and location of enrollment differed between Ad 5 seropositives and Ad 5 seronegative, I wonder if this study had a arm with gay man with circumcision and how that play a role in the final analysis of the data.

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  • 3. At 1:54pm on 24 Nov 2010, Anna Forbes wrote:

    These trial results raise a number of interesting and pressing questions. Although the trial enrolled men and transgender women, its results and the prospect of PrEP have some specific implications for women. Several of these are addressed in an article published on RH Reality Check at http://www.rhrealitycheck.org/blog/2010/11/23/pill-prevent-what-iprex-results-mean-women.

    Thank you for your excellent coverage of this complex issue.

    Anna Forbes, MSS

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  • 4. At 10:23pm on 24 Nov 2010, John wrote:

    I think such comments that HIV is coming under control, has the potential to give people false hope and become careless. There is much we still do not know about this Virus, and in view of the fact we can not cure a comparatively simple virus group that gives rise to the Common Cold, it is perhaps still too early to make such claims. It is progress, but this is a Virus that mutates rapidly, and whose origins we do not fully understand. We already face untreatable bacterial infections due to the miracle of anti-biotics and their misuse, we do not know the implications of these anti-viral treatments. Research has to understand fully the mechanics of virus life cycle, before we can really get excited.

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  • 5. At 5:36pm on 04 Dec 2010, Grace Daniel wrote:

    the treatment of the HIV & AIDS when the treatment will stop because many people are dyeing because of the virus, on drugs can stop the virus? PLEASE let the doctor do something about it.
    regard

    Grace Daniel

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  • 6. At 6:52pm on 06 Dec 2010, U14714220 wrote:

    This comment was removed because the moderators found it broke the House Rules.

  • 7. At 09:49am on 09 Dec 2010, Icebloo wrote:

    I am amazed the media is still blaming gay men for the rise in infections. Haven't they done enough already to make gay men look evil ?

    There is a HUGE increase in HIV in western countries amongst heterosexuals over 70. In nursing homes and in their own homes people who have lost their wives/husbands are having sex with new partners and are not using condoms. Why is this ignored ? This is an epidemic in western countries but obviously the media cannot demonize old people - it's much easier to continue to attack gay men because no one jumps in to defend gays.

    This biased reporting is why so many people believe all gay men have HIV/AIDS. This kind of reckless reporting has resulted in murderers being more socially accepted in our society than tax-paying, law-abiding gay people. This biased reporting is the reason heterosexuals are arrogant and ignore the risks and continue to spread the disease.

    HIV/AIDS is an EVERYBODY disease, not a gay disease. It needs to be reported as an EVERYBODY disease. We are ALL at risk.

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  • 8. At 09:54am on 09 Dec 2010, Icebloo wrote:

    1. At 07:45am on 24 Nov 2010, Megan wrote:

    Anything that can help protect those who choose a promiscuous lifestyle must be advantageous...



    How arrogant. It's people like you sitting in your ivory tower and judging others that has created the taboo about HIV/AIDS and that has resulted in the dramatic spread of the disease.
    HIV/AIDS is a risk for us all - it's not just for "promiscuous" gay men as you or the article suggests. It's time to end the ignorance and the hatred. It's time the heterosexual world took it's own responsibility for the spread of this dreadful disease instead of always blaming gay men. This disease has been and continues to be spread by both heterosexuals and homosexuals and it also affects people who don't choose a "promiscuous" lifestyle.

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  • 9. At 4:20pm on 10 Dec 2010, U14717142 wrote:

    This comment was removed because the moderators found it broke the House Rules.

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