FROM A PRESS RELEASE
The New England Journal of Medicine has published the results of the world's first efficacy trial of an HIV-prevention approach called oral pre-exposure prophylaxis ( PrEP ) —and data shows an estimated 43.8-percent reduction of new HIV infections among men who took an antiretroviral tablet daily to prevent the disease compared to those who took placebos, according to a press release from International Rectal Microbicide Advocates ( IRMA ) .
Jim Pickett, director of advocacy at AIDS Foundation of Chicago and IRMA chair, said, "This discovery alters the HIV prevention landscape forever. While this level of efficacy is relatively strong, PrEP is not quite ready for prime time and work remains before this strategy is rolled out. However, we are thrilled to have a new prevention option beyond male and female condoms visible on the horizon."
The trial analyzed the safety and efficacy of the antiretroviral ( drug TDF/FTC ( brand name: Truvada ) , taken once daily for HIV prevention among HIV-negative gay men, transgender women and other men who have sex with men ( MSM ) . There were 2,499 total participants, and they were residents of Peru, Ecuador, South Africa, Brazil, Thailand and the United States.
As for factors that led to the successful use of Truvada, taking the pill regularly was deemed most important. Regular HIV testing and ongoing monitoring by a physician were also critical.
Pickett added that some men might need to adopt a different strategy to taking medication: The study team found that about half of the men in the active arm of the trial were in fact not taking their pills regularly, if at all. It is not clear why this happened, but it certainly suggests that alternate means of using [ antiretrovirals ] to prevent HIV infection may be more acceptable for these men. The primary means of transmission among gay men and other MSM is through unprotected anal intercourse. If we develop an ARV as a gel or lubricant applied rectally—a rectal microbicide—it could be more acceptable for some individuals who don't like taking pills."
The world's third rectal microbicide trial is currently underway with sites in Pittsburgh, Penn.; Boston, Mass.; and Birmingham, Ala. Scientists are testing the rectal safety and acceptability of tenofovir gel, a microbicide developed for vaginal use that has shown promise for preventing HIV through vaginal intercourse. Depending on the outcome of this new study, the gel could be further evaluated to determine if it can be applied to both men and women who engage in receptive anal intercourse.
