July 14, 2011
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
As part of the usual flurry of studies released just before major scientific meetings, results of two pre-exposure prophylaxis (PrEP) trials in heterosexual men and women have just been made public:
So, the score so far on PrEP studies: four positive (if you include CAPRISA 004, which used tenofovir vaginal gel, and of course iPrEX) and one negative (FEM-PREP, in women). Other key (if unsurprising) findings are that PrEP works better if you take it and that it's pretty safe.
One possible interpretation of these results is that we should do everything we can to get HIV-negative individuals from serodiscordant couples on PrEP as soon as possible.
If the final results of 052 are as impressive as the glimpse we've received thus far, one could see oral PrEP becoming a strategy limited to high-risk individuals who do not have steady partners (e.g., MSM similar to those in iPrEx, or certain individual from hyperendemic areas).
Which means that the best way to prevent HIV with meds is usually to treat those who have it -- and only rarely to treat those who don't.
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.