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posted Friday, November 26, 2010 - Volume 38 Issue 48
Retroviral drug may block HIV transmission
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Retroviral drug may block HIV transmission

by Mike Andrew - SGN Staff Writer

A retroviral drug combo used to treat HIV infections may block transmission of the virus, a study released November 23 shows.

The study was conducted by the J. David Gladstone Institute at the University of California-San Francisco, and is published in the New England Journal of Medicine.

Researchers said that the drugs tenofovir and emtricitabine - packaged as a once-daily pill and sold under the brand name Truvada - reduced HIV infections by an average of 44% among Gay and Bisexual men who took the drug, compared with those taking a placebo.

Men who reported being the most diligent about taking their pill each day reaped an even bigger benefit, reducing their infection rate by 73%.

'This is a huge step forward,' lead researcher Robert Grant told reporters.

The UCSF study involved 2,499 Gay and Bi men and Transgender women in six countries, including the U.S., who have sex with men.

The participants were divided into two groups - half were given Truvada and half received a placebo. All of the volunteers were advised to use condoms and take other precautions to avoid getting sexually transmitted diseases.

'Everyone was told not to rely on this pill, because they might be getting a placebo,' Grant says.

After slightly more than a year of treatment, 36 people who were getting Truvada became infected with HIV, compared with 64 infections among those getting a placebo.

An analysis of 34 of the 36 people in the Truvada group who got HIV found that they had very little of the drug in their blood or none at all, suggesting they weren't taking the drug as prescribed.

Those with measurable amounts of Truvada in their blood had 13 times greater protection from infection, says Anthony Fauci, of the National Institute of Allergy and Infectious Diseases, which sponsored the study.

'That translates into more than a 90% reduction in risk,' Fauci says.

Truvada was chosen because it is highly effective, has relatively few side effects, and is less likely to promote HIV resistance than other drugs.

Since its approval in 2004, Truvada has become the world's top-selling AIDS drug, with more than $2 billion in sales last year, according to IMS Health, a medical information company

David Paltiel of Yale University said that his research shows that Truvada could be as cost-effective a prevention method as those used to combat heart disease, diabetes and cancer, in spite of an $8,700 annual cost.

Fauci cautioned that HIV is far too widespread to yield to a single new prevention approach.

Paltiel agreed. 'This drug alone isn't going to stop this epidemic,' he said.

Federal health officials warned that the study does not establish whether the drug works in groups other than Gay and Bi men and Trans women, adding that the work of analyzing the findings and crafting prevention guidelines has just begun.

'It's no time for Gay and Bisexual men to throw away their condoms or abandon other ways to prevent HIV,' says Kevin Fenton, director of HIV prevention at the Centers for Disease Control and Prevention.

Over the next two or three years, researchers hope to determine whether Truvada also works in heterosexuals and drug users and whether it can prevent infection if taken intermittently, or just before having sex.

Nevertheless, the findings have sparked new enthusiasm in a field where, for many years, optimism was rare.

A string of failures in HIV-prevention research - of 37 trials, only six have been successful, three of them involving male circumcision - prompted researchers to try to determine whether drugs capable of stopping HIV from multiplying could prevent infection, Grant says.

Over 30 years, HIV has infected 40 million people. But this year alone, researchers have demonstrated that a pill and a vaginal gel (containing a component of Truvada) can prevent HIV and shown, at least in concept, that a vaccine can work.

Even if Truvada is effective only for Gay and Bi men and Trans women, it could still play an important role in limiting the spread of HIV/AIDS.

According to Fenton, the HIV epidemic is still growing among Gay and Bi men. They now account for more than half of roughly 60,000 new HIV infections that occur nationwide each year, he said.

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