July 7, 2015

The First HIV-Prevention Drug is Available—Where Is The Buzz?

In her recent post, guest blogger Lauren Schrader discusses the HIV prevention drug treatment Truvada.

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Photograph of the anti-retroviral drug Truvada.

Photograph of the anti-retroviral drug Truvada.

Each year, 2 million new people are infected with HIV worldwide. At present, our most effective tool in preventing the spread of HIV is condoms, but what if we could do more? In the United States, despite a huge push for condoms–especially within the gay community–condom use is still far from perfect. Only 1 in 6 gay men use condoms every time, and even with flawless use, condoms are only 86% effective at preventing the spread of HIV during anal sex.

Despite scientists’ best efforts at finding a cure for individuals with HIV and AIDS, we aren’t there yet. However, in 2012 a drug was approved by the FDA which, when taken daily, can prevent the contraction of HIV.

Pre-exposure drugs offer a promising solution to HIV prevention, yet hardly anyone is using them: only 1,774 prescriptions were filled in two years, even fewer than were used in the clinical trial.

What Is It?

The pill is called Truvada PrEP, and it has been on the market since 2004 as Truvada, a treatment to slow progression to AIDS in patients already infected with HIV. In 2012 it became the first drug approved by the FDA for use in uninfected individuals to help reduce their risk of HIV infection (The PrEP stands for Pre-Exposure Prophylaxis). Truvada PrEP is 92% effective against HIV contraction when taken regularly and has very few side effects. The daily pill regimen can be prescribed by a doctor to any individual they determine is at “high risk” for HIV exposure.

Who Should Use It?

The CDC has outlined the high-risk individuals who could benefit from PrEP treatment as:

  1. Individuals in a sexual relationship with someone who is HIV positive
  2. Couples trying to conceive when one partner is HIV positive
  3. Anyone who is not in a mutually monogamous relationship who has sexual partners of unknown HIV status
  4. Individuals who are not using condoms consistently, especially for anal sex
  5. Injection drug users
  6. Sex workers

Any individual starting a Truvada PrEP regimen must first be determined to be HIV negative and continue to be tested for HIV every three months. Truvada is not meant to be a simple quick fix; it is prescribed as part of a treatment plan that includes safer-sex counseling and/or drug treatment counseling and free condoms.

How Does It Work?

Truvada and Truvada PrEP are made from drugs called antiretrovirals. HIV is different from traditional viruses (the common cold, for example) in the way that it spreads in the body. While other viruses have their own DNA they use to reproduce, HIV is a retrovirus and has RNA as its genetic material. Once inside a human cell, HIV uses a helper enzyme called reverse transcriptase to reverse its RNA to make DNA and then inserts itself into the strands of human DNA that are copied within cells. The human cells then reproduce the virus unknowingly and indefinitely while the virus proceeds to attack immune cells necessary for fighting off infections.

Truvada interferes with this DNA-hijacking method used by HIV by inhibiting its helper enzyme reverse transcriptase. Without this enzyme, the HIV virus cannot be converted to DNA to insert into host DNA, and thus cannot reproduce and infect the individual. This effect is only possible with a constant dose of the Truvada drugs present in the blood stream, which is why it must be taken every day.

Drug Resistance From Non-Supporters

Rather than exuberantly embracing the treatment as health experts expected at the release of Truvada PrEP, many condemned the drug. There is generally resistance among the medical community to putting  healthy individuals on any daily medication. Entire organizations disapproved and the AIDS Healthcare Foundation even lobbied against FDA approval of the drug. They were concerned that a preventative option like PrEP would undo all of the work of the condom movement and lead to riskier sexual behaviors. The phrase “truvada whore” has even emerged on the internet as a sort of pharmaceutical slut shaming.

The AIDS Healthcare Foundation also cited concerns about patient noncompliance, specifically patients not taking their Truvada every day. Without sufficient levels of Truvada in the blood, patients are no longer protected but may still feel a sense of security, resulting in HIV transmission and potential drug-resistance. Baby boomers who lived through the AIDS crisis of the 1980s worry that the new generation is becoming too nonchalant about the dangers of HIV, perceiving it as a treatable nuisance and letting their guards down.

What’s Next For Truvada?

Despite these concerns, Truvada still gained FDA approval and is on the market. As a preventative measure, Truvada is more effective than condoms and could become a very practical solution to slow the transmission of HIV among those who are high-risk. Social media campaigns like “daily blue” are appearing on the radar, but it is going to take bigger pushes from the CDC, WHO, and other organizations to market the product before Truvada becomes mainstream and widely available. Above all, Truvada is an important benchmark in the fight against AIDS. It is among a handful of developing transmission-prevention drugs including gels and an HIV vaccine offering light on the horizon in the decades-long battle against this dreadful disease.

For more information, explore the San Francisco AIDS Foundation website about PrEP.

Lauren Schrader graduated from Indiana University Bloomington, with a degree in Anthropology and specialization in Human Biology. She is continuing her education at Indiana University Bloomington to pursue a Masters degree in Public Health.