Prevention Of HIV Is Better Than No Cure

GayPeople not infected with HIV could be taking antiretro-viral drugs on a daily basis in the future.
This comes as scientists in several countries conduct research into the use of the anti-Aids drugs to prevent HIV infection.
Researchers from the United States’ Centres for Disease Control and the National Institutes of Health hypothesise that giving an uninfected individual a daily pre-exposure of antiretrovirals (ARVs) may prevent that individual from infection by disabling or interfering with the HI virus within a period after an individual is exposed to the virus.
The drugs would work in a similar way to anti-malaria tablets, which protect individuals who take them before visiting a malaria area.
Clinical trials to determine the efficacy of pre-exposure prophylaxis (PrEP) in humans – using either a single ARV, Tenofovir, or a combination of drugs, Tenofovir and Emtricitabine – are under way in Botswana among heterosexual couples in which one partner is HIV-infected; in Peru among men who have sex with men; and in Thailand among injecting drug users.
Trials are also being conducted in Ghana among high-risk women and in the US among men who have sex with men. No studies are as yet being conducted in South Africa.
Results of the clinical trials are expected late next year or in 2008.
But PrEP is unlikely to be 100% effective because the HI virus is known to develop resistance to ARVs, and this means it will still need to be used in conjunction with other prevention methods.
Professor Helen Rees, executive director of the University of the Witwatersrand’s Reproductive Health and HIV Research Unit, says PrEP isn’t a “magic bullet” but could be “another weapon in our armoury against HIV infection”.
Rees adds that the effectiveness of PrEP would ultimately be determined by people’s behaviour.
“If a person increases their risk behaviour by increasing their number of sexual partners or reducing condom use, the benefits gained by PrEP may be lost,” she says.
In countries with an emerging epidemic, according to Rees, an effective prophylactic is likely to be given to people in high-risk groups, such as sex workers, injection drug users and migrant workers.
In a country like South Africa, which has a more generalised epidemic and where women between the ages of 20 to 24 are considered high-risk, a policy decision would have to be made on who has access to the prophylactic drug.
Dr Francois Venter, president of the Southern African HIV Clinicians Society, says that even if PrEP becomes available, “it would only be a small part of the jigsaw puzzle of prevention methods”.
Venter isn’t certain how many people would choose to take a chemical substance – which may have side-effects – to protect themselves rather than use condoms.
Antiretroviral drugs have already been shown to prevent HIV infection, with thousands of children being protected from infection through mother-to-child prevention programmes.
In addition, providing post-exposure prophylaxis (PEP) to healthcare workers immediately after accidental exposure to the HI virus and to rape survivors within 72 hours after the attack, has also been proven to prevent infection.
But with almost 5-million new HIV infections occurring every year, the world is hard-pressed to find additional ways to prevent the spread of the disease.
Although behaviour interventions – abstinence, reducing the number of sexual partners, partner selection, using male condoms and female condoms, and needle hygiene – have been shown to be effective methods of prevention, these are not consistently used by individuals, are not univer- sally effective and have not ultimately been able to contain the epidemic.
It is widely believed that in addition to effective behavioural change, biomedical approaches to HIV prevention will be required to adequately curb the spread of the virus. But even if the current human trials are successful, the introduction of PrEP as a prevention method is a long way off.
Rees explains that many other questions will be raised if PrEP is found to be effective.
“Researchers would have to turn their attention to drug resistance, drug toxicity, drug pricing, the cost-effectiveness of the approach and whether people will adhere to taking the drug daily,” she says.
from The Star / Jillian Green

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