On Dec. 11, the AIDS Foundation of Chicago ( AFC ) conducted an informational webinar on potential new methods of PrEP ( pre-exposure prophylaxis ).
PrEP is a set of preventative antiretrovirals taken consistently by an HIV-negative person who is at high risk for becoming HIV-positive. Jim Pickett, the director of prevention advocacy and gay men's health at AFC, said he hopes that PrEP will provide individuals with more options for protection. "The more tools we have to protect ourselves during sex the more protected sex we will have. … We have to have things that fit into people's lives and that work for people," said Pickett.
The current form of PrEP is the pill Truvada. "An HIV-negative person can take this pill every day and be very well-protected against HIVwell upwards of 90 percent, edging toward 100 percent," said Pickett. The FDA ( Food and Drug Administration ) approved Truvada in 2012. So far, said Pickett, "We're seeing [insurance] coverage pretty much across the board." Gilead, which manufactures Truvada, offers co-pay and medication-assistance programs, and the Illinois Department of Public Health will offer its "PrEP for Illinois" assistance program beginning in January ( as reported in Windy City Times on Dec. 4 ). However, "the retail cost of Truvada is expensive. It is between $14,000-$15,000 a year," Pickett said.
There are several alternatives to Truvada currently being tested. Many of these drugs are microbicides ( products applied topically that help prevent the spread of sexually transmitted infections ). "You can think of it as PrEP in a lubricant PrEP in a fiber," said Pickett. The results of a study using the microbicide tenofovir are expected in late 2015 or early 2016. The microbicides miraviroc and dapivirine are currently in phase-one drug trials in gel form. "Johns Hopkins just got a $5 million grant to develop rectal douches into microbicides," Pickett said. A number of other drugs are currently under development as possible injectables.
Although many studies are being conducted, clinicians may not yet be well-informed about PrEP. "The clinicians who are being approached ... in many cases, they are not people who are used to providing HIV services. And now, they're being asked to provide an HIV drug that normally, in their view, has been only used for treatment. [It's] not being provided for negative people in an ongoing way for prevention," said Pickett.
The Centers for Disease Control and Prevention, or CDC, has developed a flyer ( at tinyurl.com/talkPrEPtoDr ) that offers the public questions and guidelines for speaking with their doctors. It also provides informational resources to give clinicians and further resources for the general public. The University of California at San Francisco now offers a PrEP line that provides expert guidance to clinicians who are considering providing PrEP to their patients; call 855-448-7737.