Pre Exposure Prophylaxis: Another Step in the Fight Against HIV

There could be many different hypothetical HIV related scenarios that a person may find themselves becoming privy to; for the sake of this article we’ll use the scenario of a person who is HIV negative being in a sexual relationship or happening upon an encounter with a person who has tested HIV positive. The “barriers” that are associated with current modes of prophylaxis that prevent transmission from one to another become tedious and are said to make the experience, while safe, less enjoyable. For people in these situations who have these reservations about condoms and other protective sexual equipment are now being given a lighter cross to bear.

 

HIV/AIDS has made its staple on the population since its introduction in the early 1980s, claiming more than 39 million lives, and stigmatizing more than 70 million world-wide in its wake.  Infection transcends race, gender, and basic demographic because the disease itself has no respect of person. It only replicates as any disease knows how. For years the populations of the world have been asking for an answer to combat and, hopefully, eradicate this monster of a disease. The answer, it seems, has made its début in the form of a small pill. PrEP which stands for Pre Exposure Prophylaxis was approved by the U.S Food and Drug Administration in 2012.  It is marketed as a new HIV prevention method in people who do NOT have HIV infection to reduce the risk of becoming infected.

 

PrEP combines two medications in one. The first medication, Emtriva treats HIV and Viread, which treats HIV and Hepatitis B viruses and both work to slow down the progression of the the diseases. Neither one of these drugs, alone or by themselves, are prescribed medications to eradicate HIV or AIDS. In its conception, during clinical trials, there were very few early side effects documented. Individuals who participated in early studies saw loss of appetites, upset stomachs, and mild headaches which usually went away within the first month of taking the medication.

 

Along with specific expectations for the daily adherence to the medication regiment, the pill was created as a way to decrease the number of infections per year. The supposed reckless behavior of the high risk individuals who this medication is marketed towards has put them at a disadvantage; but this medication could very well be the answer to those barriers, limitations, and stigmas that testing positive entails. Uninfected individuals at high risk for sexually transmitted HIV infections include:

  • Individuals with HIV positive partners
  • Individuals who engage in inconsistent or no condom use
  • Diagnosis of sexually transmitted infections, those who exchange sex for commodities, use illicit drugs, persons with alcohol dependency, persons who are incarcerated, and/or have sexual partners with unknown HIV statuses

One of the recent studies for PrEP was performed by iPrex. This was a randomized, double blind, placebo controlled, multinational clinical trial that included 2,499 HIV negative men or transgender women who have sex with men. In this trial, subjects were chosen randomly to receive TRUVADA. 1,251 received actual pills and 1,249 of the subjects received the placebo medication. The subjects received monthly HIV testing, condoms, counseling, and management of other transmitted sexual infections. The study proved to have a 42% risk reduction in HIV-1 acquisition versus that placebo that was given to its subjects.

HIV-1 sero conversion (the period of time which HIV antibodies develop and become detectable) was observed in 131 subjects. Sero conversion generally takes place within a few weeks of the initial infection. They are often, but not always accompanied by flu like symptoms including fever, rash, muscle aches, and swollen lymph nodes. Among the current studies that are under way in regards to PrEP related medications are:

  • Maraviroc – taken orally once a day and works by blocking entry of HIV into the bodies of the cells.
  • Replivire – injected once a month as a long acting formulation and works by blocking an enzyme called HIV reverse transcriptase. By blocking this enzyme it prevents the virus from replicating in the body.
  • Dapivire – released by a vaginal ring that is worn for four weeks at a time. This works by binding to and disabling the HIV reverse transcriptase enzyme.
  • Tenofovir – one part of the already approved combination pill with TRUVADA. It is currently being studied as a part of a microbicide gel that is inserted or applied vaginally or rectally.

HIV/AIDS are no longer the death sentences that they once were. Medical advancements have rendered them close to harmless. The only real enemy that it has is the stigma that is associated with it. It binds and disregards while perpetuating a fear of things that people are hard pressed to not understand. As new ways to “play safe” arise, we hope that the stigma that is associated with this disease will to fall by the waist side and will not be tolerated. Only then will individuals move away from being afraid of it to creating and implementing creative and productive ways of fighting it.

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