Wed 24 Nov 2010 In: New Zealand Daily News View at Wayback View at NDHA
A study which shows a drug used to treat HIV-positive patients may offer men who have sex with men some protection against contracting the virus is being met with hope, but HIV experts say there are still three significant hurdles: its cost, the risks of drug-resistant strains of HIV developing and taking a drug treatment every day. The results from the first-ever human study of a treatment called pre-exposure prophylaxis (PrEP) have shown it to be effective in reducing sexual transmission of HIV. The clinical trials, published in New England Journal of Medicine, gave 2,499 HIV negative gay and bisexual men a combination of two antiretroviral (ARV) drugs. The results showed that HIV infections were 44 percent lower in the group taking PrEP than the control group which took a placebo. Antiretroviral drugs are used to treat people living with HIV and have been credited with dramatically reducing the mortality rate from AIDS in developed countries but this is the first trial to use ARVs as a preventive measure. New Zealand AIDS Foundation Executive Director Rachael le Mesurier says there is the potential for PrEP to play a role in HIV prevention and the Foundation is very hopeful that the study will lead to further research into making PrEP more effective. However Le Mesurier says despite the promising results, there are numerous challenges ahead. She says ARVs used in the study are available in their component parts in New Zealand but not in a single pill and the cost is significant. "This drug would cost more than $10,000 per person, per year, in New Zealand and at 44 percent effective, it's still no match for condoms and lube which have an efficacy rate of more than 90 percent. Everyone involved in HIV prevention and healthcare here, and around the world will be considering PrEP carefully and how it fits with other HIV prevention interventions." The NZAF points out access to ARVs remains extremely difficult around the world. It says UNAIDS has estimated that only 36 percent of people living with HIV who need ARVs could access them just one year ago which means that the roll-out of PrEP for HIV negative people is highly unlikely in countries where access to ARVs is already seriously limited. In addition to these issues, the Foundation says adherence poses another challenge to PrEP. It says study participants learned about PrEP and the importance of adherence as part of the trial but researchers reported that only about half of study participants took the medication consistently. The Foundation says compounding the problem of adherence is the challenge of developing communication strategies about an intervention that is just 44 percent effective - and only when taken in combination with a full complement of prevention services. "This study opens the door to new possibilities. However, with World AIDS Day coming up next week, it's a very timely reminder that we are still in the midst of an epidemic in New Zealand and that we still don't have a silver bullet to stop HIV. Condoms and lube are still the best way to prevent HIV," Le Mesurier says. Australia's largest community based HIV/AIDS organisation ACON says the results are promising, but says more research is required. CEO Nicholas Parkill told Samesame.com.au, "The results of the iPrEx study may offer the potential for a significant future advance in HIV prevention. "However the 44 percent reduction in HIV incidence achieved in this trial will need to increase significantly in further studies before pre-exposure prophylaxis can be termed a success. "It's very early days and a great deal of further investigation and analysis will be required before trial-based efficacy can translate into real life practice. Parkhill agrees with Le Mesurier that using condoms and lube remains the most effective protection against HIV transmission. Sir Nick Partridge of British AIDS charity the Terence Higgins Trust has told The Telegraph, "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. "For now - and for the foreseeable future - condoms remain the most effective, easily available and cheapest way of preventing HIV transmission."
Credit: GayNZ.com Daily News staff
First published: Wednesday, 24th November 2010 - 6:48pm