Work to reduce the spread of HIV, the virus that causes AIDS, has slowed the rise in the annual number of reported new cases of the virus, from a peak of 3.25 million cases in 1997 to roughly 2.6 million last year, a new United Nations report finds. But with an estimated 33.3 million people globally now infected with the virus, there’s still much work to be done to restrain spread of the virus and the AIDS epidemic. A new study on the efficacy of Truvada against AIDS infections raises hope for a significant breakthrough.
The study, published Tuesday by the New England Journal of Medicine, has found that men who daily took Truvada, a common combination of two anti-retroviral drugs, were far less likely – up to more than 90 percent less likely – to become infected by HIV than men who took a placebo.
As a whole, the 2,499 men in the six-country study were only 44 percent less likely to get HIV. Researchers, however, learned from the subjects’ blood work that many did not take Truvada daily as instructed, because their blood work showed no signs of the drug. Excluding those, researchers found that the men whose blood tests confirmed that they had actually taken their Truvada pill every day were more than 90 percent less likely to get HIV.
“That’s huge,” exclaimed Dr. Anthony S. Fauci, head of the infectious diseases division of the National Institutes of Health. “That says it all for me.”
Others will surely agree. Indeed, it’s the best news in the battle against the spread of HIV/AIDS in years.
The study, financed by the NIH and the Bill and Melinda Gates Foundation, was conducted among subjects in Brazil, Ecuador, Peru, South Africa, Thailand and the United States. Subjects were instructed to use safe-sex practices, but it was known that many would not always do so, nor would they all faithfully take the Truvada pill daily. The chief difference in the efficacy of Truvada was found to be in the consistent daily use of the pill.
This is especially heartening because the drugs used in Truvada are readily available in many countries. In the United States, Truvada, produced by Gilean Sciences, costs around $12,000 to $14,000 yearly and is paid for under many insurance programs. But in poorer countries, a generic version of the medicine may cost as little as 40 cents a day.
Its wide availability makes it useful as a daily pre-exposure prophylaxis. Since it attacks the virus in the bloodstream, it also lends itself to use by people who otherwise may not use condoms or be able to direct condom use by a partner. Researchers cite several such circumstances: prisons where vulnerable men are subject to rape; situations in which women and men cannot control a partner’s use of condoms; people prone to ignore safe sex practices when they are drunk.
There are caveats about use of the drug, to be sure, and regimens for its use as a preventive to HIV infections are not yet developed or approved.
Expense clearly also will be an issue. Many millions of people at risk for HIV infections and AIDS live in countries in Africa, Asia and Eastern Europe where access to the drug may be unavailable or unaffordable. Globally, barely 5 million of the people with HIV infections are on anti-retroviral drugs. Their sex partners may not know they carry the infection, or be able to protect themselves.
Against such challenges, there remains compelling reason to continue vigorous educational and health care campaigns against HIV/AIDS, and to encourage the use of condoms and safe sex. Still, the study on the efficacy of Truvada and the potential for curbing AIDS gives rise to new hope in the struggle to bring the dreaded disease under control.