HIV Digest	HIV Digest Archive

Use of anti-HIV meds as "post exposure prophylaxis" (PEP) is intended for rare, one-time exposures -- not for repeated use. For people who are exposed to HIV on a regular basis, a more controversial approach is being studied: the use of HIV meds to prevent infection before exposure. Called PrEP, for pre-exposure prophylaxis, it is based on the common practice of using antiretrovirals to prevent HIV transmission in pregnancy.

Current PrEP studies are using either Viread (tenofovir) or Truvada (tenofovir plus emtricitabine). These products were chosen because they are taken once daily, can be taken without food, and have strong safety records, limited side effects, and favorable resistance profiles.

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here have been concerns that people may use PrEP before studies are complete, thinking they are protecting themselves from HIV. Rumors abound that some gay men are already using PrEP, including a "new cocktail" at sex parties called "MTV" (Meth, Tenofovir, and Viagra). But a CDC survey given at gay pride events in 2005 showed that out of 397 HIV-negative gay men, only one person had used PrEP, while five had used PEP. Almost 19 percent said they had heard of PrEP, indicating that though the concept is somewhat known, its use is not widespread.

If PrEP is proven effective, understanding its impact on HIV risk behaviors will be critical. One of the greatest risks is that people will reduce their use of proven prevention strategies. Because no single strategy will likely be 100 percent effective, reducing transmission will require integrating all available methods -- both biomedical and behavioral. During trials, all participants must receive state-of-the-art HIV risk-reduction counseling and other proven HIV prevention interventions.

Even if these trials demonstrate that PrEP can reduce HIV transmission, it is equally important to understand whether persons at risk will be willing and able to maintain consistent use of a daily drug. These trials will therefore closely examine participants' adherence to, and acceptance of, daily drug use.

Drug resistance will also need to be addressed during trials. Unlike PEP, which has been so effective that developing resistance has not appeared to be a problem, it is unclear how often resistance will develop if PrEP fails.

It's important to remember that if PrEP is found to be effective, it will need to be a part of a comprehensive HIV prevention program that includes education, empowerment, and proven risk-reduction behaviors. At the same time, after 25 years of HIV, many people are clearly hoping for something other than a lifetime of rubber-insulated sex.

from TheBody.com