PrEP Work

In November an unprecedented study on the use of the antriretroviral medication Truvada to combat HIV infection indicated what experts had long assumed: that the method, known as pre-exposure prophylaxis (PrEP), largely works. Those who took the pill 90% of the time as instructed by researchers had 73% fewer infections than those given a placebo.

Despite the findings, the champagne remains corked. PrEP in the real world is expensive -- as much as $14,400 a year -- and difficult for most to access. And just last week the U.S. Centers for Disease Control recommended that only high-risk gay and bisexual men utilize the therapy, which has not yet been approved for use by HIV-negative individuals by the Food and Drug Administration.

So The Advocate asked Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (which cofunded the study), what real benefits this research will have in fighting the spread of HIV.

Note: This interview was conducted before the CDC's latest guidelines for use of PrEP.

The Advocate: Given the size of this study, the results are impressive. But what concerns do you have about PrEP?
Anthony Fauci: The takeaway message here is that the more prevention modalities we have, the better off we are. And this study tells us that we now have another tool. But the best way to avoid infection remains consistent and effective use of condoms and a decrease in [number of partners]. I'd want the gay community to realize that this isn't a substitute for another type of prevention. The infection rate hasn't budged in the last 10 years, no matter how hard we try. So we should at least put this on the table.

Is it risky to give antiretroviral medication like Truvada to someone who doesn't have HIV?
There's an 18-month follow-up study to examine any toxicity resulting from [Truvada] that we may have missed. Thus far it looks good.

Does PrEP require additional research?
Well, we've shown that PrEP is effective in men who have sex with men, and we have ongoing trials on multiple continents looking at effectiveness in women, heterosexuals, young adolescents. There's no reason to believe we're going to see any different result.

How challenging will it be to make PrEP a viable option to stop HIV infection?
It's a tough question. We don't even have enough resources to treat people who are already infected -- how can we justify using resources to buy drugs for the long run? But given the cost of treating people for a lifetime -- as well as hospitalization costs -- new investment in prevention might be cost-effective in the long run.