Is PrEP the new cure?

by Rob Howard
Associate Editor

It's the new little blue pill. Truvada, that is...and it may save your life. But only if you know about it, can afford it, and take it regularly. The FDA approved Truvada for “Pre-Exposure Prophylaxis,” or PrEP, in 2012, and US treatment guidelines recommend initiation of treatment for all those testing HIV-positive.

Despite that, start of treatment has been slow. The Centers for Disease Control (CDC) estimates there are 500,000 people in the US who may benefit from PrEP, but fewer than 10,000 are currently using it.

“Truvada is 95 percent effective if taken as required,” said Adrian Soto, HIV Prevention Educator at Oklahoma City’s Red Rock Behavioral Health Services. “They have to take it every day.”

In addition to using Truvada, “It’s still important to use protection. Even though Truvada is effective against HIV, it doesn’t protect against other sexually transmitted diseases,” said Soto. He noted that Oklahoma has been experiencing a big outbreak of Syphilis, which can be prevented by using condoms.

At the CDC’s 2015 National HIV Prevention Conference in early December, there was a lot of discussion about PrEP. The issues involved are complex. “PrEP and treatment as prevention are new strategies for HIV prevention but these tools will have limited impact on helping to end the epidemic without active community engagement and uptake. Targeting PrEP to those at highest risk—young gay/MSM (men having sex with men) and women of color and transgender people—reduces incidence and saves money,” wrote Cindra Feuer and Deirdre Grant, who presented a paper on ways to accelerate the use of PrEP, and engaging more people in care.

“Testing, HIV care, treatment and viral suppression save lives and reduce onward HIV transmission. PrEP and HIV treatment/viral suppression are two key components of high impact prevention, also known as combination prevention,” they continued.

There are many reasons for taking Truvada, according to Soto. “A lot of people who want to use Truvada are not using protection, or they are taking it to reduce their risk of infection, or are part of a serodiscordant couple,” he said. A couple is serodiscordant when one person is HIV-positive, and the other is HIV-negative.

Part of the problem with getting more people on PrEP, regardless of the reasons they would use it, is a lack of knowledge and medical care. Out of all those in the US living with HIV, only 30 percent are virally suppressed, and only about half of MSM diagnosed with HIV are engaged in regular health care.

CDC estimates that 1,218,400 persons aged 13 years and older are living with HIV infection, including 156,300 (12.8%) who are unaware of their infection. A new CDC study shows that 9 out of 10 new HIV infections come from those not receiving care. Prevention of new infections depends on reaching people who are HIV positive with testing, treatment and care.

Effectively getting the word out about HIV, its prevention, and treatments available is not a new problem. HIV/AIDS organizations, the CDC, and healthcare organizations have carried on education, prevention, and testing programs for decades now.

Feuer and Grant wrote, “Science tells us that increasing PrEP access and engaging more HIV-positive people in care and treatment could prevent tens of thousands of new HIV infections.” Their presentation aimed to build community understanding and support for ARV-based prevention so that these strategies do not remain underused.” ARV stands for Anti-Retroviral drugs; Truvada is an ARV.

Part of the problem in Oklahoma with getting more people using Truvada as PrEP, according to Soto, is that many doctors are not aware of the drug, or of ARV prevention strategies. “And,” he says, “we don’t have a lot of doctors who will prescribe it.”

Even when people know about the availability of Truvada, another problem to starting treatment is the drug’s cost. “A month’s supply of Truvada costs about $1,500,” says Soto. If you have health insurance with drug coverage that will cover it, the insurance may pay the entire cost of the drug, or have a low co-pay of $35 or $50 each month.

For very low-income people who are uninsured, Soto noted that they have access to programs that will provide Truvada without cost.

In early December, “HIV/AIDS activists, among them the originators of ACT UP, gathered in New York City,” according to Towleroad.com. “Larry Kramer, Peter Staley, Jim Eigo, Matt Ebert, and James Krellenstein released a joint statement regarding their meeting calling for an end to profiteering by pharmaceutical companies with regard to PrEP (pre-exposure prophylaxis).”

In their statement, posted on Facebook by Peter Staley, the group said, “Although we may not see eye-to-eye on every issue we debated tonight, we all agree that Pre-Exposure Prophylaxis (PrEP) is highly effective at protecting a person from HIV infection.”

The activists were highly critical of Gilead Science’s monopoly on drugs that prevent and treat HIV, and the high prices the company charges. Truvada is a Gilead product.

The activists touched on another problem with HIV treatment. “While PrEP isn’t for everyone, any individual who thinks they are at risk of getting HIV should have easy access to it, without judgement.”

There is a stigma associated with being HIV-positive. Soto agrees, noting not only the stigma of having the disease, but stigma associated with the use of Truvada. “Some people think that people who take it are sleeping around. Some people on FB are referring to people as ‘Truvada whores,’” he said.

Prevention of HIV is a major component of the CDC’s work, but education about PrEP, and drugs like Truvada are an important component of the fight to achieve an AIDS-free generation. Soto says that when he tests a person, “I tell them about Truvada. There are more people who are asking about it.”

If you think you are at risk of being infected, you should talk to your doctor about Truvada and PrEP. Adrian Soto said if you have questions about Truvada, PrEP, or HIV testing and prevention, you should feel free to call him at (405) 778-6367, Monday through Friday, 10 a.m. to 6 p.m.

The Gayly – January 17, 2016 @ 12:30 p.m.