A Pill a Day to Keep HIV Away?
Even if the method works, can it do more harm than good?
What if there was a pill you could take once a day to keep from contracting HIV? That idea may not be as crazy as it sounds.
In countries around the world, scientific studies involving thousands of participants are looking at whether a person who does not have HIV can take a once-a-day, anti-retroviral pill to keep from getting infected with the virus during sexual encounters. A growing number of scientists, activists and government officials are anxiously awaiting the results of seven clinical trials. Below the radar, excitement is bubbling and experts from community organizations, the Centers for Disease Control and the White House are quietly discussing the best ways to roll out this so-called pre-exposure prophylaxis—known as PrEP—if it works.
“We are embarking on a national dialogue about a national HIV/AIDS strategy,” says Jeffrey Crowley, who was appointed head of the National Office of AIDS Policy earlier this year. He spoke to a gathering of several hundred attendees interested in PrEP at the National HIV Prevention Conference in Atlanta earlier this week.
“The president articulated three HIV/AIDS goals, and the first was reducing HIV incident. [PrEP] could be an important piece of that issue, but we need to maintain a balance of being excited about it while also being cautious.”
Even as interest grows, this experimental treatment has been saddled with controversy. Around the world, 33 million people live with HIV/AIDS, 1 million in this country, and globally, the majority of those infected don’t have access to lifesaving treatment. So is it fair to use desperately needed medication for prevention rather than to save lives? Also, if the drug is used incorrectly, the virus could become “resistant” to it. In other words, it could stop working.
“These are my two big anxieties,” says Dr. Connie Celum, a professor at the University of Washington and the principal researcher on a PrEP trial being conducted in Kenya and Uganda. “First, are we taking away resources from treatment if we use the medication for prevention? And the second is about resistance. Yes, there’s a lot of promise, but we have to be realistic that there’s still a lot of work to be done.”
Some study results are expected later this year, and if the medication does work, it could be a boon for HIV prevention. A new way to prevent the spread of HIV is desperately needed. During the Bush years, there was no wide-ranging, coordinated effort to prevent the spread of HIV in the U.S. Though the federal government vowed to cut the rate of new infections in half by 2005, the number has remained constant. Recent, adjusted estimates place new infections at 56,000 per year—actually an increase from previous numbers.
African Americans account for half of people living with HIV in the U.S.—510,000—and nearly half of new infections. One of the key ways to curtail the spread of HIV is through comprehensive sex education. But that effort has been hampered in the U.S.—and around the world—by American policies that have tied funding to the teaching of abstinence only, both in the U.S. and in nations around the world.
As far as PrEP, studies of monkeys have shown promise, and, in theory, the idea should work. Anti-retroviral drugs have prolonged the lives of people living with HIV/AIDS, and the medication is given to people—mainly health care workers and victims of sexual assault—who have been exposed to HIV to reduce the risk of transmission. And giving anti-HIV medication to pregnant women can prevent the passing of the virus from mother to child.
“This isn’t a radical idea,” says Dr. Celum. “There’s a rich history of using prophylaxis to prevent infection, including HIV infection.”