PrEP: A New Tool in the Battle Against HIV

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Playing Pill to Prevent HIV?

More than 1 million people are living with HIV in the United States, according to the Centers for Disease Control and Prevention, and an estimated 50,000 people are newly infected each year. The World Health Organization estimates 35 million people are living with HIV around the world. Despite a noted decrease in the number of new infections in the 1990s, the incidence rate has since plateaued.

Twenty years ago, national dialogue about the risks of unprotected sexual activity, as well as numerous representations in the media of the devastating effects of the disease, led to a greater understanding of the importance of safe sex practices. However, as the epidemic seemed to come under control, awareness efforts declined and subsequently, the drop in infection rates has come to a halt.

Actor Daniel Frazese, who plays an HIV-positive gay man in HBO’s Looking, hypothesizes that one reason the infection rate has leveled instead of continuing to drop is the nation, and specifically the entertainment industry, has turned its attention to new issues, and Americans have lost sight of the seriousness of the potentially deadly disease.

HIV, or the human immunodeficiency virus, is a virus that spreads through the exchange of bodily fluids, such as blood, semen and vaginal fluids, and destroys certain cells within the body’s immune system. Over time, the infection can damage the immune system to the point that it no longer can fight off infections or disease, resulting in AIDS. There is no cure for HIV, though certain antiretroviral therapies can help control the disease and prolong the life of a patient. There are several actions people can take to help prevent contracting HIV, including limiting their number of sexual partners, avoiding shared needles and engaging in safe sexual practices, like using condoms correctly and consistently. 

In addition to lifestyle habits that can reduce the risk of transmission, viral specialist Dr. Jorge Rodriguez says that the FDA recently approved a medication, commonly used to treat HIV patients, which now also can be used for individuals who are at high risk for contracting the dangerous disease. He explains the drug is a pre-exposure prophylactic, meaning that if taken correctly and consistently, it can protect an individual if they come into contact with the virus. He notes that the drug, which has been shown to be up to 97 percent effective at preventing HIV infection, is only effective if taken every day.

“I kind of cringe a little when they say it’s for gays,” Dr. Rodriguez says. “It’s for anybody that has blood and that has sexual contact with other people in an unprotected fashion.” He notes that PrEP could be revolutionary for mixed-status couples (in which one partner is HIV positive and the other is negative), both homosexual and heterosexual.

“You have to use safe sex,” Dr. Rodriguez emphasizes. “This is an extra layer of protection. By no means am I saying this is the holy grail.”

Currently the only PrEP drug approved for use is Truvada, a medication that has been in use for 10 years as part of a cocktail to treat HIV. It contains two medicines, tenofovir and emtricitabine, which work together to block the virus from establishing a permanent infection. The drug does carry a small risk of certain long-term side effects, including a decrease in kidney function and osteoporosis, so patients will require check-up appointments every three months. 

ER physician Dr. Travis Stork asks whether the advent of this medication could make the younger generation, who perhaps missed the AIDS scare of the 1980s, more carefree when it comes to sexual activity.

“I don’t think promiscuity is really the issue here,” counters Daniel Franzese of HBO's Looking. “The issue is we have tools to cut down new infections by 96 percent if we use them. Now, today, we can really eradicate the disease. We can end HIV and AIDS if we’re using the proper tools.”

Family medicine physician Dr. Rachael Ross adds that increased education about avoiding risks and using protection also can help reduce the incidence of HIV. Dr. Rodriguez notes that safe sex practices are only effective when actually used. “To think that people are always being safe out there is a fantasy,” he says.

Learn more about PrEP, and hear how Dr. Rodriguez balances the risks and benefits of prescribing the medication for his patients: