Truvada, the first pre-exposure prophylaxis (PrEP) medication approved by the Food and Drug Administration that reduces the risk of infection in uninfected people who have sex with HIV-infected partners, isn’t being as widely used as it should be. This is in spite of studies that show the therapy is nearly 100 percent effective.
“I see this as the birth control for HIV,” said Mariam Salas, M.D., a fellow at the University of New Mexico’s Division of Infectious Diseases.
Part of the reason for the lackadaisical attitude toward PrEP, Dr. Salas said, can be attributed to common misconceptions about HIV. She hears them from her patients all the time:
- HIV is no longer an epidemic.
- People doesn’t really die anymore.
- Abstinence and condoms are working just fine.
These misconceptions aren’t just wrong, she said, they’re also dangerous. There are still 50,000 new cases of HIV in the United States every year, data that hasn’t changed in a decade. The ethnic group most affected by the continuing epidemic: African Americans. We make up 44 percent of the new cases of HIV, though we’re only 12 percent of the U.S. population.
“There’s a 1 in 20 risk in black men,” Dr. Salas said, “a 1 in 48 risk in black women. For black men who have sex with men, there’s a 1 in 2 risk. Black men who have sex with men are more likely to contract HIV than they are to be in a car accident, be incarcerated or graduate from college.”
Even more startling, two out of every five new infections will be in someone between the ages of 13 and 25. “The virus that is not an epidemic is hurting our children the most,” Dr. Salas said.
These facts are why she recommends PrEP in her practice. “HIV PrEP works. More than 10 published trials to date show PrEP is effective,” she said. “We’ve seen a 44 percent reduction in HIV, a 92 percent reduction in those with good adherence. The only FDA-approved PrEP, Truvada, is well tolerated and drug resistance is not seen. Those who got HIV during the study, shockingly, weren’t taking the medication. If you don’t take it, it doesn’t work.”
Taking one tablet of Truvada daily is also cost effective. One HIV infection costs almost $300,000 a year. PrEP costs $3,000 a year. According to Dr. Salas, PrEP is covered by most insurance companies. Gilead has patient assistance program for people without insurance.
So who needs PrEP?
- People who are having sex without condoms.
- People in a relationship with someone with HIV.
- Someone with recent sexually transmitted infections. Particularly vulnerable populations include sex workers, IV drug users and those recently out of rehab or prison.
- Special populations, which include pregnant women and adolescents. “Truvada is not FDA approved for [either population], but we’ve used it for decades in pregnant women,” Dr. Salas said. Each state has its own laws regarding prescribing the medication to children.
Who shouldn’t get PrEP?
- People with an active HIV infection “If you have it, this medication is not going to help you,” Dr. Salas said.
- People with kidney dysfunction
- Anyone with an allergy to Tenofovir
- Anyone with an active hepatitis B infection
Once PrEP has been prescribed, patients still need to be monitored. Dr. Salas checks her patients every three months for an adherence visit, to do a screening test for HIV and to give a pregnancy test to women. Every six months she checks creatinine levels and performs an STI screening.
Is PrEP the solution to our HIV problem? No, and Dr. Salas doesn’t claim it is. “If there’s a pill that can fix our HIV problem, I haven’t heard of it yet,” she said. “But PrEP gives patients options.”
This post appeared first on Black Health Matters.
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