Does Truvada Really Work in Prevention of HIV?

HIV Africa

Does Truvada Really Work in Prevention of HIV?

For decades, society and science have joined hands, hoping to find the cure for AIDS. The very anticipation of such a breakthrough has been feverish for some time now, which makes us wonder, why isn’t the prevention of the HIV virus—perhaps one step away from finding the cure for the disease itself—bigger news than it has been? More to the point, why do various sources seem uncertain to label Truvada a success?

Long before AIDS begins to ruin lives, an estimated 50,000 people will receive the bad news of an HIV positive test in the United States alone. According to the latest research, Truvada, also called PrEP, comes very close to doing what has formerly been just a dream. By its indications, it has the capacity to prevent people from transmitting the human immunodeficiency virus during sexual activity. While this is not exactly a cure, it is somewhere in the territory of one, since the medication does enter the cells of the infected individual and prevents the HIV replication that starts rapid T cell depletion, immune system collapse and infection, which culminates in a steady progression to AIDS. The two inhibiting drugs that make up Truvada are Tenofovir and Emtricitabine.

The government has officially acknowledged the scientific value of Truvada, since the Center for Disease Control has admitted that Truvada can be effective in blocking transmission and a has success rate as high as 92 percent. For over a decade, scientists have been studying Truvada’s effects

The first serious test was done in 2010, an iPreEX study, and covered in the New England Journal of Medicine, that followed respondents who showed a 44% protection increase from HIV. The study was conducted using research from 2,499 men or transgender women who were sexually active with other men. The final analysis suggested that there was a 92 percent reduction in the risk of HIV transmission.

More tests are being done studying the drug’s effect over a longer period, but two recent tests were disappointing.

First, a study of 5,000 women in Africa covered in the New England Journal of Medicine called VOICE reported that three products including, Truvada and Tenofovir gel, were safe for usage. However, it was not overwhelmingly effective in preventing transmission. The Tenofovir gel group, using the product reduced HIV risk by 39 percent in one study, which was a success. However, Truvada was not considered as effective in its study, mainly because of an adherence issue.

Namely, that subjects were not using the products as instructed, which required daily dosing. Within three months, blood tests revealed that many women had been dosing incorrectly, or perhaps had stopped taking the product entirely. The Tenovovir gel product did not require daily dosing, but was to be applied before and after sex, hence adherence was not a significant an issue.

The US Food and Drug Administration has already approved Truvada for HIV prevention use because of its promising science, and two studies (the iPrEx study and the Partners PrEP Study).

The FEM-PrEP study in Africa was less promising, and without regular daily dosage its efficiency level dropped 44 percent. While it’s true that human factors are preventing a greater success story happening here, the stubborn reality is that we can’t expect to prevent HIV on a larger, global scale unless the adherence issue is addressed. If people can forget to take life-saving medication, then they will forget, and thus the spread of HIV remains a threat just the same.

Besides the troubling adherence issue, another factor worth mentioning is that of a possible misunderstanding of Truvada and the prevention-protection it gives. Dr. Adam Zweig of the AIDS Healthcare Foundation stated that Truvada could even be abused as a recreational drug, and lead users into greater sexual risks, if they mistakenly believe Truvada is a 100 percent effective means of prevention.

This could have even more dire consequences if, as Zweig states, “the spread of other sexually transmitted diseases and HIV…if that happens, [people] could develop HIV resistance and potentially spread a resistant virus to other people.

In fact, Zweig’s own organization officially spoke ill of the product, suggesting that widespread use of the drug is not a wise idea. However, given the FDA’s approval, and doctors who have no other options at this point, many sexually active individuals are being prescribed Truvada—approximately 3,200 people or more over the last three years.

The most alarming statistic here is not the low efficacy of Truvada, which has human factors working against it, but the very high number of HIV cases being reported—and the ones not being reported. Many sexually active people don’t even know if they have an STD, because of ignorance and a refusal to get regularly tested.

Despite Truvada’s imperfections, there is enough evidence to conclude that using it will not harm the individual, nor will a low preventative rate be considered a major factor, especially in light of the fact that no other means of prevention is available except condoms. Price remains another legitimate concern, considering that an annual cost of a Truvada habit is upwards of $8,000 or more.

Adverse side effects of Truvada (as well as other anti-virals) include nausea, an excess production of lactic acid in the blood, liver problems, and a worsening of symptoms in hepatitis B patients.

The real success story will come when treatment can go well beyond prescribing the drug to a small number of the total population exposed to an HIV threat. A vaccination shot would be ideal, such as what has been done for prevention against the human papillomavirus, would be the next logical step in winning the war against AIDS—assuming of course, that the miracle cure remains elusive.

 

http://fox5sandiego.com/2015/02/04/debate-brews-over-hiv-prevention-pill/

http://www.biznews.com/health/2015/01/20/pill-prevent-hiv-yes-arent-people-risk-taking-truvada/

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1011205

http://www.eurekalert.org/pub_releases/2015-02/mtn-fro020215.php