Yes, you can use pills to prevent AIDS, review finds

Maggie Fox

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July 10, 2012 at 7:25 PM ET

Drugs used to control the AIDS virus can also be used to protect uninfected people, researchers concluded on Tuesday in a “last-word” review of the data.
Their report, released in the Cochrane Library, bolsters calls for policies backing distribution of the drugs to people most at risk from the virus -- including gay and bisexual men, drug users, and women in some African-American communities as well as across the developing world.
The findings also underscore the debate over how best to use scarce resources to fight the pandemic of human immunodeficiency virus or HIV, which infects 33 million people globally, including more than a million in the United States. It has killed 25 million people. There is no cure and no vaccine.
But studies are showing hope on several fronts.
“We think we are at the beginning of the end of the AIDS epidemic,” Dr. Diane Havlir, an AIDS specialist at the University of California, San Francisco, and one of the organizers of a giant, international AIDS conference being held in Washington, D.C. later this month, told reporters on Tuesday. “Over the past three years, there has been a series of breakthroughs in interventions that can dramatically curb the rate of infections with HIV.”
Work on a vaccine is promising, it’s been shown clearly that circumcising men protects them from infection, and it’s also obvious that treating infected people not only keeps them alive and healthy, but it helps prevent them from infecting others. Work is also progressing on a microbicide -- a gel that women could use to protect themselves from infected husbands and partners. And now research is also showing that giving people a once-a-day dose of the pills used to treat HIV can keep them from becoming infected in the first place.
The studies on this last approach, called pre-exposure prophylaxis or PrEP, have been mixed. So Charles Okwundu of Stellenbosch University in South Africa and colleagues studied the studies.
They looked at experiments involving more than 9,800 people around the world at high risk of becoming infected with HIV, including gay or bisexual men and sex workers. The drug tenofovir alone -- sold under the brand name Truvada by Gilead Sciences -- cut the risk of HIV infection by nearly two-thirds, while trials using Truvada with a second drug called emtricitabine, brand name Emtriva, cut the risk by 49 percent, they reported in the Cochrane Library, a journal that seeks to find the “last word” on studies.
It’s not clear why using two drugs seemed to be less effective than using just one, but the trials were done very differently and using different groups of people.
"Our findings suggest that antiretroviral drugs can reduce the risk of HIV infection for people in high risk groups," Okwundu said in a statement. "However, in the search for highly reliable HIV prevention strategies, it is important to determine how pre-exposure prophylaxis can best be combined with existing programs, as no strategy is likely to be 100 percent effective."
Okwundu’s team noted controversy over using PrEP.
“One concern is the long-term side effects of antiretroviral drugs used over many years by uninfected individuals,” they noted.
These include possible kidney damage and bone loss. In addition, if people don’t take the drugs consistently, they could develop what is known as resistant virus -- infections that defy the use of drugs. This can hurt the patients themselves, and they can also pass this resistant and hard-to-treat virus to others.
“There also are concerns that PrEP will lead to an increase in high-risk behavior,” Okwundu’s team adds. “If PrEP is not completely effective, even a partial reduction in use of safer sex could lead to an increased rate of HIV transmission.”
And the drugs are expensive -- Truvada costs more than $1,000 a month in the United States, although Gilead allows for much cheaper generic versions to be made and distributed in the developing world.
Despite the concerns, in May a panel of Food and Drug Administration advisers recommended that the FDA approve the pills for this use. Already, doctors can and often do prescribe the pills as they like, but FDA approval would clear the way for U.S. insurance companies to pay for it and

Once-a-day pill prevents HIV in drug users

 

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June 12, 2013 at 3:50 PM ET

Getty Images file /

Here's what the AIDS medication Viread, the brand name tenofovir is sold under, looks like.

A once-a-day pill can protect people who inject drugs such as heroin from the AIDS virus, lowering their risk by nearly 50 percent, researchers reported Wednesday.
The findings show that even people at the highest risk of being infected with the virus can protect themselves – and thus protect others. And it adds ammunition to arguments that HIV drugs should be made widely available to fight the epidemic that has killed more than 25 million people.
The study, published in the Lancet medical journal, demonstrates the value of pre-exposure prophylaxis, PrEP for short, the researchers say.
“Our trial is the first evidence that PrEP can reduce HIV risk among people who inject drugs,” said Dr. Amy Lansky of the Centers for Disease Control and Prevention. “It does become another strategy that we have to use in preventing HIV in this population,” Lansky said in a telephone interview.
PrEP has already been shown to protect people who are infected sexually, by far the most common way that the AIDS virus is transmitted. Doctors believe the once-a-day pills stop the virus from infecting immune system cells.
“This is an important study,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who was not involved in the study. “There were people who said you couldn’t treat injecting drug users at all.”
There’s no cure for the human immunodeficiency virus (HIV) that causes AIDS. But cocktails of drugs can keep it under control and keep patients healthy for years, even decades. And the same drugs can be used to prevent infection. Newborn babies are given drugs such as nevirapine to prevent their mothers from infecting them, and several studies have shown the spouses and sexual partners of infected adults can take another drug, called tenofovir, and lower their risk by as much as 62 percent.
The virus can be spread sexually, in blood and in breast milk. About 11 percent of cases are in people who inject drugs; about 8 percent in the United States.
Injecting drug users are usually endangered in at least two ways – they often share needles, which can transmit the virus, and they often also indulge in risky sexual behavior. Drug users can spread the virus to non-drug users via sex.
Thai health officials, Bangkok city officials and the CDC collaborated on a study to see if these hard-to-reach people might be helped. They recruited 2,413 uninfected drug users in Bangkok, randomly assigning them to get either one pill a day of tenofovir, donated by Gilead Sciences, the company that makes it, or a placebo.
Tenofovir is the drug shown to protect people from sexual transmission and it’s a very safe drug, says Lansky. “It has a pretty long half-life,” she says. “It is staying in the body and having an effect over time.”
After an average of about four years, 17 of the volunteers who took tenofovir got infected with HIV, compared to 33 of those who got dummy pills. That’s a reduction of 49 percent. And among those who took the pill the most consistently, the reduction rate went up to 74 percent.
“It’s a really important finding. It provides that last piece of PrEP’s efficacy among popoulations at high risk,” Lansky says.
“This is a significant step forward for HIV prevention. We now know that PrEP can work for all populations at increased risk for HIV,” added Dr. Jonathan Mermin director of CDC’s Division of HIV/AIDS Prevention.
The researchers also got good compliance -- the volunteers in their study may have been drug users, but they showed up in the clinics, took their medications and stayed in touch for years.
Dr. Salim Karim, Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), said it’s one more tool for fighting the virus, which infects 2.7 million people every year, including about 50,000 in the United States. “The introduction of PrEP for HIV prevention in injecting drug users should be considered as an additional component to accompany other proven prevention strategies like needle exchange programs, methadone programs, promotion of safer sex and injecting practices, condoms, and HIV counseling and testing,” Karim wrote in a commentary in the Lancet.
The CDC had updated its guidance on PrEP, and recommends that people who inject drugs such as heroin should get a once-a-day pill called Truvada, which contains both tenofovir and another HIV drug called emtricitabine.
“Nevertheless, while expanded HIV treatment for those with HIV infection is essential, it will not be sufficient to end the epidemic. Even if we can improve treatment outcomes for all of those diagnosed with HIV, individuals who do not know they are infected are likely to continue to unknowingly transmit HIV infection to others,” the CDC added in a statement.
Activists said the evidence was building up but not enough is being done to make use of proven methods to fight the epidemic.
“We now need to get serious about making PrEP available to those who can benefit,” said Mitchell Warren of the advocacy group AVAC. “More than two and a half years after the first positive results from a PrEP trial, little has been done to answer critical questions about the best ways to roll out daily oral PrEP to key populations worldwide. Within the next year, a comprehensive package of demonstration projects should be planned, funded and launched in countries around the world.”

What is the difference between HIV and AIDS?

HIV is the virus which attacks the T-cells in the immune system.

AIDS is the syndrome which appears in advanced stages of HIV infection.

HIV is a virus.

AIDS is a medical condition.

HIV infection causes AIDS to develop. However, it is possible to be infected with HIV without developing AIDS. Without treatment, the HIV infection is allowed to progress and eventually it will develop into AIDS in the vast majority of cases.

HIV testing can identify infection in the early stages. This allows the patient to use prophylactic (preventive) drugs which will slow the rate at which the virus replicates, delaying the onset of AIDS.

AIDS patients still have the HIV virus and are still infectious. Someone with AIDS can pass HIV to someone else.

‘It is worse than the pain of contracting the disease’

‘It is worse than the pain of contracting the disease’

Shanthinath (name changed), who is undergoing treatment for AIDS in the city, has not been visited by his family for the past seven years.

“Whenever I try to meet my family members, the elders do not allow younger ones to touch me.”

Mr. Shanthinath, who is at Snehasadan — care and support centre for those infected and affected with HIV/AIDS — was isolated when his family learnt about his disease. “It was worse than the pain of contracting disease”. He is now serving as the caretaker for other patients in the centre.

Another patient was so humiliated when she was with her family found some solace only after she joined the centre.

A 37-year-old HIV positive from Koppal district has kept his and wife’s condition a secret because the situation would be “unimaginable” if people came to know about it.

Even as the district has made considerable strides in containing the spread of the disease, the stigma associated with the disease continues to haunt patients with even those in healthcare sector being ignorant about the way the disease spread.

A medical officer associated with Anti-Retroviral Therapy (ART) at Wenlock Hospital said, “Even some of the doctors and nurses hesitate to speak to HIV patients.”

She said there are cases of private hospitals refusing to treat persons with AIDS particularly if they have open wounds.

Kishore Kumar of the Dakshina Kannada AIDS Prevention Control Unit pointed out that lack of awareness among people about the disease was responsible for the stigma and the problems patients faced because of it.

He said Red Ribbon Clubs have been started in 32 colleges in Mangalore to create awareness through drama, street plays and demonstration. The fact that youths are more vulnerable to contract the disease brings the issue of stigma into greater focus.

Most persons registering at Snehasadan are in the age group of 20-35 years.

***

39-year-old Pooja (name changed) contracted HIV 12 years ago when she was in Mumbai. Soon she returned to her mother-in-law in Udupi.

Six months later she was shown the door forced to stay at her mother's place.

Her husband, also an HIV positive, committed suicide unable to fight the stigma. Pooja has been in the Snehasadan for nine years now along with her daughter, who is also an HIV positive.