Thevirus that leads to AIDS, human immunodeficiency virus, or HIV, causedan odd illness that was a complete medical mystery only about 25 yearsago. Now, HIV infects more than 40 million people around the globe, andeach day, some 14,000 more people pick up that infection, studies haveshown.
While scientists continue to try to develop more effectivedrug treatments and possibly vaccines one day, and health educatorscounsel people to avoid risky behavior, still more weapons are neededto fight the stubborn scourge, they say.
Writing in today’s(Sept. 30) issue of the journal Science, an international team ofresearchers, clinicians and others explains that a promising,relatively new approach is for people not infected but at high risk totake drugs that might prevent them from contracting HIV. But debateover the particulars of the strategy has slowed progress.
"Evenas available and proven prevention interventions are used, the HIVpandemic will not be stopped solely by talking to those at risk," theywrote. "Clinical trials of daily oral antiretroviral dosing aspre-exposure prophylaxis, or ‘PrEP,’ have been initiated in Africa,Asia and the United States and are planned in Latin America.Unfortunately, these trials have become controversial."
Authorsof the commentary include Dr. Robert M. Grant, associate investigatorat the Gladstone Institute of Virology and Immunology and associateprofessor of medicine at the University of California at San Francisco;Dr. Myron Cohen, professor of medicine and epidemiology at theUniversity of North Carolina at Chapel Hill schools of medicine andpublic health; and 16 others from as far away as Peru and Ghana. Cohenalso is chief of infectious diseases at UNC Hospitals.
"HIVPrEP research, as with all aspects of the fight against HIV/AIDS, isbuilt on partnerships between sponsors, investigators, communities andgovernments," the authors wrote. "Cooperation among such diverseinterests is never easy, and coalitions are easily fractured by acts ofdisrespect, misinformation or miscommunication.
"Such actsoccurred too frequently in the early days of PrEP research, and hardlessons have been learned on all sides. While good faith efforts aremade to improve the conduct of trials, a balance must be struck betweenthe necessity to conduct trials to very high standards and the need tofind ways to prevent the spread of HIV infection."
Concerns aboutPrEP trials first generated widespread publicity during theInternational AIDS Conference in Bangkok in 2004. Following proteststhere, preparations for a drug trial in Cambodia were suspended. InFebruary this year, the government of Cameroon did the same.
Themost promising PrEP drug to date is tenofovir disoproxl fumarate orTDF, which has an excellent safety record. Gilead, the company thatdeveloped it, has established a global access program that will allowit to be sold at cost in 95 countries. It also plans to set up anon-exclusive licensing agreement with a drug manufacturer in SouthAfrica.
"I think PrEP may prove to be a safe and cost-effectiveway to prevent HIV," Grant said. "We cannot know until the research iscompleted."
Other authors are Dr. Susan Buchbinder of theUniversity of California at San Francisco, Dr. Edith Clarke of theGhana Health Service in Accra, Ghana, Dr. Thomas Coates of theUniversity of California at Los Angeles, Martin Delaney of ProjectInform in San Francisco, Guiselly Flores of Peru’s Women Living withHIV/AIDS and Dr. Willard Cates Jr., Dr. Kathleen M. MacQueen and Dr.Leigh Peterson of Family Health International.
Others are PedroGoicochea, Dr. Jorge Sanchez and Dr. Javier Lama of the Health andEducation Association in Lima, Greg Gonsalves of Gay Men’s HealthCrisis in New York, N.Y., Mark Harrington of Treatment Action Groupalso in New York City, Dr. John P. Moore of Cornell University’s WeillMedical College, Dr. Melanie Thompson of the AIDS Research Consortiumof Atlanta and Dr. Mark A. Wainberg of the McGill University AIDSCenter in Montreal.
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