The Future of HIV Prevention: Truvada PrEP
HIV Infection and AIDS
The human immunodeficiency virus (HIV) causes an infection that currently has no cure. The virus affects the immune system and over time, can destroy it to such an extent that acquired immunodeficiency syndrome (AIDS) develops. At this stage, an infected person can no longer fight off other infections and diseases.
Research over the last couple of decades has led to new medicines and treatments that allow people to live with HIV for much longer than ever before, and without developing AIDS.
Transmission and Incidence of HIV
HIV is transmitted from one person to another through bodily fluids. According to the Centers for Disease Control and Prevention (CDC), the virus is mostly spread through unprotected sex and the sharing of drug needles in the United States.
The most recent data from the CDC show that the incidence of new HIV infections in the United States in 2010 was around 50,000. Although the number is stable, government agencies such as the CDC hope to bring the number down with new treatments and preventions.
PrEP for Prevention
Medications for treating HIV have improved. However, prevention is still an important factor in reducing the incidence of the disease. To that end, people who at high risk for developing the virus are encouraged to use pre-exposure prophylaxis (PrEP).
PrEP involves taking daily medication that helps to prevent the transmission of an HIV infection. It also includes other risk-reducing techniques, such as treatment for drug addicts or education about safe sex practices.
FDA Approval of Truvada
The Food and Drug Administration (FDA) approved Truvada, the drug being used for PrEP, in 2012. The FDA had already approved Truvada as a treatment used in combination with other drugs to treat patients with HIV.
Truvada must be taken daily as a prophylactic medicine. FDA approved the drug as a preventive measure with the provision that patients must also participate in education and counseling to help reduce their risk of infection.
The Proof Is in the Research
The FDA approved the use of Truvada as part of a comprehensive PrEP program because research shows that it can reduce infection rates. One such study from the CDC saw a significant drop in the risk of infection among participants.
The study included 1,200 sexually active men and women. Researchers found that there were 63 percent more infections in the placebo group compared to the group that received Truvada daily.
Truvada for Drug Users
Another study from the CDC showed that Truvada PrEP was also effective in preventing infection among intravenous drug users. Over 2,000 drug users participated in this study. The risk of infection in those taking Truvada instead of placebo was reduced by 49 percent.
Some of the participants reduced their risk by an even greater amount. These were the drug users that strictly adhered to the daily pill regimen.
Cost of Prevention
Peace of mind can be expensive. NPR reports that Truvada PrEP can cost as much as $36 a day. Other estimates range from $8,000 to $14,000 a year. Although this cost is high, the cost of treating a patient with AIDS is estimated to be over $25,000 a year.
The good news is that the cost of treatment is often covered by private and public health plans. There are also programs available from the manufacturer and other groups to help offset the high price tag of PrEP for those without health insurance.
Side Effects Can Be Unpleasant
According to the CDC, early studies have shown that PrEP has a good safety profile. No serious safety concerns emerged in people who have taken PrEP.
Possible side effects of Truvada include stomach pain, headache, and weight loss. If you’re taking Truvada with other anti-HIV medications, you may experience symptoms like sleeping problems, dizziness, nausea, or depression. Some people stop taking the drug correctly because of these side effects.
More serious complications include kidney problems, bone thinning, body fat changes, and inflammation.
Are You a Candidate for Truvada PrEP?
Truvada PrEP is intended for use by anyone who’s at a high risk of developing an HIV infection. This includes people who engage in unprotected sex with multiple partners and intravenous drug users who share needles.
Any uninfected person in a relationship with someone who has HIV is also at risk and eligible to use Truvada prophylactically.
Who Can’t Use Truvada PrEP?
The FDA states that Truvada PrEP should only be used by people known to be HIV-negative. Anyone using the prevention program has to be tested for the virus first and again every three months.
Truvada should not be used by anyone with bone or kidney problems or hepatitis B. The medication may worsen these conditions.
Dropping the HIV Infection Rate
The incidence of HIV infection has hovered steadily around 50,000 for several years. Government agencies like the CDC and FDA hope that the introduction of Truvada PrEP will help to bring this number down.
While a steady number is better than a rise in infections, a drop in HIV incidence would be the best possible outcome.
- Bangkok Tenofovir Study: PrEP for HIV Prevention Among People who Inject Drugs. (2013, June). Centers for Disease Control and Prevention. Retrieved August 6, 2013, from http://www.cdc.gov/hiv/pdf/prevention_research_prep_BTSfactsheet.pdf
- Food and Drug Administration. (2012). FDA approves first drug for reducing the risk of sexually acquired HIV infection [Press release]. Retrieved August 6, 2013, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm
- Fulton, April. (2010, November 23). Pill Cuts HIV Infection Risk Significantly, For a Price. All Things Considered, National Public Radio. Retrieved December 31, 2013 from http://www.npr.org/blogs/health/2010/11/23/131536422/pill-cuts-hiv-infection-risk-significantly-for-a-price.
- HIV Incidence. (2013, May 22). Centers for Disease Control and
Prevention. Retrieved August
6, 2013, from http://www.cdc.gov/hiv/statistics/surveillance/incidence/index.html
- HIV Transmission. (2013, June 3). Centers for Disease Control and Prevention. Retrieved August 6, 2013, from http://www.cdc.gov/hiv/basics/transmission.html
- Paying for Truvada. (2012). Gilead Sciences. Retrieved January 2, 2014 from http://www.truvada.com/truvada-patient-assistance.
- Pre-Exposure Prophylaxis. (2013, April 15). Centers for Disease Control and Prevention. Retrieved August 6, 2013, from http://www.cdc.gov/hiv/prevention/research/prep/
- Pre-Exposure Prophylaxis. (2013, June). Centers for Disease Control and Prevention. Retrieved January 1, 2014 from http://www.cdc.gov/hiv/prevention/research/prep/.
- Pre-Exposure Prophylaxis (PrEP). (2013, September 27). AIDS.gov. Retrieved January 6, 2014, from http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/
- Pre-Exposure Prophylaxis (PrEP) to Prevent HIV Infection: Questions and Answers. (2012, December). New York State Department of Health. Retrieved December 31, 2013 from http://www.health.ny.gov/publications/0265/.
- Preliminary Results from First Safety Study of Daily Tenofovir for HIV Prevention Among MSM Find No Significant Concerns. (2013, April). Centers for Disease Control and Prevention. Retrieved January 1, 2014 from http://www.truvada.com/truvada-patient-assistance.
- Schackman, BR et al. (2006, November). The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 44(11):990-7. Retrieved January 1, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/17063130
- TDF2 Study of Pre-Exposure Prophylaxis (PrEP) Among Heterosexual Men and Women in Botswana: Key Facts. (n.d.). Centers for Disease Control and Prevention. Retrieved August 6, 2013, from http://www.cdc.gov/nchhstp/newsroom/docs/PrEP-Heterosexuals-Factsheet.pdf
- What information are you looking for?. (n.d.). TRUVADA (emtricitabine and tenofovir disoproxil fumarate). Retrieved January 6, 2014, from http://www.truvada.com/