Towards a day-before anti-HIV pill?
There was PEP (Post Exposure Prophylaxis) and now there might be PrEP, Pre-exposure prophylaxis.
PEP is a course of anti-HIV medicines taken daily over the course of a month after exposure to the HIV virus usually after a condom breakage during sex.
PrEP, on the other hand is an unproven strategy in which HIV negative people take an antiretroviral drug or combination of antiretrovirals, on a regular basis in the hope of reducing their risk of acquiring HIV.
Clinical trials of PrEP are currently planned or underway in countries in Africa, Asia, Latin America and North America. The idea of using PrEP goes back a few years ago when tenofovir (Viread) was going to be tested in Cameroon and Cambodia until the trials collapsed even before starting under the pressure of irresponsible activists.
But with the disappointing results that have come out from recent studies of vaccine and microbicide candidates, PrEP is back on the agenda at the XVII International AIDS Conference and with it comes a lot of unanswered questions.
The urgency of the situation is such that an AVAC Report on Pre-Exposure Prophylaxis calls for Immediate planning to anticipate study results of potential new HIV prevention option.
“Anticipating the Results of PrEP Trials provides an up-to-date status report on current PrEP research; addresses concerns about PrEP, including the possibilities of drug resistance, partial efficacy, and the potential for increased risk behavior and social stigma; looks at the potential impact of PrEP on future HIV prevention research; and considers what questions should we be preparing to ask now based on possible different research outcomes as PrEP studies begin reporting data in the next few years.”
The danger is that PrEP becomes a blessing for unprotected sex as much as the belief in the success of antiretrovirals is potentially increasing the rate of unprotected sex.
Anticipating that PrEP could be successful, some already think of a “Friday night pill” to be taken before embarking on a long weekend of sex, drugs and alcohol. This would be one step further towards the normalisation of AIDS; afterall travellers do take anti-malarial tablets before journeying in a country where they would be at risk of infection. Still, PrEP would leave a bitter taste in many mouths.
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From The Independent today:
One British researcher said yesterday that the return of the bathhouse culture among gay and bisexual men, involving sex with multiple partners, could provide the scenario in which a preventive pill might be taken.
Sheena McCormack, a specialist in HIV prevention and reader in clinical epidemiology at Imperial College London, said: “The party scene involving multiple sexual partners is definitely back in London and probably in most European cities. There is metrosexual mixing involving gay, bisexual and some heterosexual cases. We estimate new HIV infections in gay men in London are running at 3 per cent a year”.
Her clinic already offers “post-exposure prophylaxis” to people who have had unprotected sex with someone in a high-risk group, involving a month-long course of treatment with three drugs. But a preventive drug would provide an extra option. “People could pop a pill on a Friday night and be covered for the whole weekend,” she said.
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