Dr. J: Will a pill a day keep HIV away?
 

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posted Friday, March 4, 2011 - Volume 39 Issue 09

Dr. J: Will a pill a day keep HIV away?
by Dr. Joanne Stekler - Special to the SGN

Joanne Stekler, MD, MPH, is deputy director of community services for the HIV/STD Program at Public Health - Seattle and King County. She is also an internal medicine and infectious disease physician at Harborview Medical Center, and assistant professor of medicine and epidemiology at the University of Washington.

This is part of a series of articles focusing on HIV and other STD prevention and care topics for Gay/Bisexual men and Transgender individuals in Seattle and King County.


Last year, a new study showed that HIV-negative men and Transgender women who have sex with men can decrease their chances of getting HIV with two medicines usually used to treat HIV: tenofovir and emtricitabine.

This idea of using HIV treatment meds to prevent HIV transmission isn't new. In the early '90s, researchers found that giving AZT to women who were HIV-positive and pregnant greatly reduced the number of babies who got infected.

A few years later, the Centers for Disease Control and Prevention recommended HIV treatment meds for anyone who is exposed to HIV through sex or sharing needles. This recommendation came from data showing that health-care workers who took post-exposure prophylaxis (PEP) after a needle stick had an 80 percent lower chance of getting HIV compared to people who chose not to take it.

So now there's evidence that taking HIV treatment meds before exposure (pre-exposure prophylaxis, or PrEP) can also decrease a person's risk of getting HIV. In last year's study, called iPrEx, researchers found that PrEP decreased new HIV infections by 44 percent. In people who took their daily meds more than 90 percent of the time, PrEP reduced the risk of infection by 73 percent. But note that the protection from PrEP wasn't perfect - 36 people in this study still got infected with HIV even though they took PrEP.

These really are exciting findings, but there are many issues to work out before we can say that PrEP should be given to Bi and Gay men in Seattle. PrEP might make it more likely that people who become infected get a drug-resistant strain of HIV. There may be long-term side effects from taking it that we don't know about yet. And then there's the issue of cost.

If you have a doctor and insurance and you're interested in PrEP, you should talk with your doctor to see if taking it is an option for you. We don't know yet if insurance will cover the costs of PrEP. If you wanted to pay for it yourself, it would cost more than $10,000 per year just for the medicines. If you don't have insurance or your own doctor, there may be other options in the future.

You should also know that it's not certain if taking HIV meds other than those used in the iPrEx study would work to prevent HIV infection. Nor is it clear that PrEP would work if it's taken with other drugs such as Viagra and crystal meth for a party weekend. So please don't take HIV meds if they haven't been prescribed for you.

And remember, PrEP holds some promise, but it didn't completely prevent HIV infection in the iPrEx study. This means that other things you are already doing to prevent HIV transmission - like using condoms, having fewer sex partners, getting tested for HIV if you're HIV-negative, and talking about HIV with partners - will continue to be key in preventing the spread of HIV and other STDs that aren't prevented by PrEP. In the next few years, you'll start to see some answers (and probably more questions) as we get results from other studies.

In the meantime&.

If you're a guy who has sex with other guys, you can get tested for HIV and other STDs at Public Health's STD Clinic, Gay City, the baths, and at your doctor's office. For hours and locations, call 206-296-4649 or go to www.kingcounty.gov/health/hiv. If you've had unprotected sex within the last 72 hours with someone who is HIV-infected, you should call the Madison Clinic (206-744-5100) to make an appointment to talk to a provider about post-exposure prophylaxis. And you can read more about PrEP at www.cdc.gov/hiv/prep.



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