MIAMI — Just before the start of this year’s International AIDS Conference, the U.S. government approved a drug to prevent HIV infection, a decision many called a turning point in the three-decade global pandemic.
“This is a watershed moment for both U.S. and global HIV prevention efforts,” said Mitchell Warren, executive director of AVAC, Global Advocacy for HIV Prevention.
One Truvada pill a day, along with safer sex practices, could reduce the risk of infection 42 percent among male partners and 75 percent in opposite-sex pairs, according to the U.S. Food and Drug Administration.
But using Truvada daily comes with a $1,200 monthly price tag and possible side effects — including diarrhea, kidney and bone damage — and some AIDS activists say the costs outweigh the benefits.
“I wouldn’t want to take the risk of this medication,” said Stacy Hyde, vice president of Broward House, which provides care and support for people with HIV in southern Florida. “Condoms are available everywhere for free. Why put your body through that? And there are so many other STDs — Truvada is not going to protect you from hepatitis C, gonorrhea, syphilis or herpes.”
In 2004, the FDA approved Truvada by Gilead Sciences as an effective treatment for those already infected with HIV. The once-a-day pill is a combination of two older HIV drugs, Emtriva and Viread.
Studies began in 2010 showing that the drug had potential to help prevent people from contracting HIV in the first place. A three-year study found that daily doses cut the risk of infection in healthy gay and bisexual men by 42 percent, when accompanied by condoms and counseling. Last year, another study found that Truvada reduced by 75 percent the rate at which an HIV-infected person in a heterosexual relationship passed the virus to his or her partner.
Gilead Sciences stresses that Truvada must be used with condoms. “You must practice safer sex at all times and do not have any kind of sex without protection,” according to the Gilead website.
Safer sex has been the mantra practically since the beginning of the AIDS epidemic more than 30 years ago. So why use Truvada, with its risks and expense?
“It’s just one more layer of protection,” said Hyde, whose Fort Lauderdale, Fla., agency sees 5,000 clients a year.
Dr. Karen Raben, one of southern Florida’s best-known HIV/AIDS specialists, said she agrees.
“This doesn’t replace safe sex. Safe sex includes condoms and not having impaired judgment,” said Raben, a Miami physician. “Not having drugs and alcohol driving the engine.”
Raben said preventive use of Truvada would most benefit couples in which one partner is HIV positive and the other negative.
The pill could also benefit someone who doesn’t know or trust his or her partner’s HIV status, said Dale Penn, a Miami AIDS activist.
“I do know someone who was in a monogamous relationship. They both tested negative, both tested negative again six months later. Three years later one of the partners became very ill, was taken to the hospital and died within a week of (AIDS-related) pneumocystis.
“When he was diagnosed, it became evident to the other partner that the monogamous relationship was a one-way street. He got infected, too. Not only did he have this dead partner — who five days before he thought he was in a monogamous relationship with — he had to deal with his own infection,” Penn said. “If he had been on Truvada, perhaps he wouldn’t have been infected.”
Penn said anyone contemplating preventive use of Truvada should speak with “their trusted physician, weigh the pros and cons, financially and medically, and then reach an informed decision whether it’s right for them.”
