Once-a-Day Pill Reduces HIV Infections—Would People Actually Take It?

By Jennifer Welsh | November 23, 2010 6:59 pm

pillsA drug called Truvada seems to be able to prevent HIV infection from taking hold in the body when taken regularly. The once-a-day pill combines two anti-retroviral drugs, and was found to reduce new HIV infections in a study of 2,500 gay men. But there are two big issues: compliance and cost.

In the study, which was published in the New England Journal of Medicine, men who took the pill were 44 percent less likely to contract the disease than those on placebo. But when the researchers looked only at the men who took the pill faithfully, the number jumped to 90 percent.

“These results represent a major advance in HIV-prevention research,” says physician Kevin Fenton of the Centers for Disease Control and Prevention in Atlanta. “For the first time, we have evidence that a daily pill used to treat HIV is partially effective for preventing HIV among gay and bisexual men at high risk of infection.” Fenton cautions, however, that the results don’t warrant abandoning other proven prevention techniques. [Science News]

While the results are certainly promising, it remains to be seen if at-risk people would take a pill every day.

[M]any men in the study failed to take all their pills, and some clearly lied about it. For example, some who claimed to take them 90 percent of the time had little or no drug in their bloodstreams. Although the pills caused no major side effects in the study, some men disliked the relatively minor ones, like nausea and headaches. [New York Times]

Truvada is already available by prescription in most countries, as one of the many anti-retroviral drugs used in HIV treatment cocktails. It is made by Gilead Sciences, and costs $36 per day in the United States (though the price drops to 40 cents for a generic version available in poor countries). With the price of a single pill so high in the United States, treatment costs quickly get astronomical. Still, NPR’s blog suggests that daily preventative pills could be more cost effective than lifetime care for AIDS patients.

Some doctors already prescribe Truvada for use as a prophylactic and more are likely to start, though health officials and researchers recommend waiting for additional studies.

“It’s vital that we expand the ways we can prevent HIV transmission, particularly amongst those most at risk,” [Sir Nick Partridge of the Terrence Higgins Trust] said in a statement. “This trial proves that HIV treatment will have an impact on prevention, but that it’s not ready for widespread use yet. Three major hurdles are still going to be its cost, the risks of drug-resistant strains of HIV developing and taking a drug treatment every day.” [BBC News]

There are still many unknowns: researchers worry that users might feel too protected and stop using condoms; the drug might not be as effective with women and heterosexual men; the drug could have toxic effects when taken continually. Further studies will probe these questions. But since most experts advocate a multi-pronged approach to fighting the HIV epidemic, the use of anti-retrovirals as prophylactics may well find a role.

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Image: Flickr/.candy

CATEGORIZED UNDER: Health & Medicine
  • Jill

    What a ridiculous sum of money to use this as a prophylactic treatment, when ACTUAL PROPHYLACTICS are much more effective, not to mention cheaper! Those patients who are likely to be compliant with pills are also the most likely to be compliant with condoms. Nonetheless, I bet the drug company’s marketing department is pushing this one to the max.

  • Jockaira

    The difference between $36 daily and 40¢ is simply the amount required for the drug company to recover its costs of development, testing, and profit. The government should buy or lease the rights from the manufacturer and make the drug available for its citizens. It would be an excellent investment in public health, and in the long term would save money in governmentally provided health insurance by reducing the total number of AIDS cases that in many instances devolve to the government for financial support.

    I seriously doubt that anyone would pay $36 daily for prophylaxis that is only 90% effective, but 40¢ is another story. Better compliance with the daily regimen could be encouraged by including a dozen condoms (at near 100% effectiveness) with 30 days-worth of Truvada. Because of the economies of scale and volume, this type of packaging would be very cheap for the user, and having both in the same package would be a nice place to include literature about both and be a good reminder to the user of the value of both systems.

    It’s pretty hard to imagine a more effective AIDS prevention kit!

  • http://www.catholiclab.net Ian

    @2, What about an AIDs avoidance kit?

  • Anna Forbes

    Thanks for raising these important cost issues. There are additional issues that should be of concern, particularly to women, as we consider the possibility of PrEP. For more on these, please see http://www.rhrealitycheck.org/blog/2010/11/23/pill-prevent-what-iprex-results-mean-women. Thanks.

    Anna Forbes, MSS

  • Jennifer Welsh

    @Jill,

    I wanted to broach this topic in the article, but didn’t have the space. The people who would be using these type of pill-based prophylaxis are a couple types: Men who might be getting raped in jail by other, possibly infected prison-mates, prostitutes who for whatever reason aren’t able to force their customers to wear condoms, and also people who may get high or intoxicated and unable to demand their partners use condoms.

    The point is, there are specific cases where this kind of treatment COULD be useful, in addition to other, currently available and proven ways to prevent HIV infection, like condoms. I hope I at least made that point in the article.

    Thanks for reading and commenting, all!

    Jen

  • Matt B.

    How long would someone have to use the pill before and after sex to get the maximum effectiveness? If the before were zero days, it could be used as a sort of day-after pill and it might have wide application.

  • Duncan

    Often once we have a pill that’s effective it’s just a matter of time before somebody develops the same treatment in a slow release medication. I assume research is being conducted into making this into something that could be taken as a booster, perhaps once a year or so? If they manage that this could be rolled like a flu shot, and then you could have some real results. Criticize the drug companies if you like, but if you don’t come up with the inefficient method first you’ll never get to an efficient one.

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