An article published in the New England Journal of Medicine
online edition today announced study results that the use daily of antiretroviral medicine reduced rate the acquisition of HIV infection. The New York Times coverage
highlighted the result that the preexposure prophylaxis protected more than 90% of study participants who took the medicine every day, as prescribed. An editorial in the NEJM noted
, however, that compliance was problematic, with only 44%of study participants protected overall.
From the NEJM editorial: “The overall reduction in HIV incidence in the FTC–TDF group was less than 50%. Although increased medication adherence would raise this degree of protection (along with the risk of potential side effects), what is the likelihood that such a regimen could be accomplished in an implementation program that lacks the intense reinforcement of adherence counseling provided in the context of a clinical trial? How can medication-use fatigue be mitigated over potentially many years of daily therapy?”
As noted in the NYT, one major question hangs over this debate: who will pay for the drug?
"In the United States, Truvada, made by Gilead Sciences, costs $12,000 to $14,000 a year. In very poor countries, generic versions costs as little as 40 cents a pill.
Globally, only about 5 million of the 33 million people with AIDS are on antiretrovirals, and, in an era of tight foreign-aid budgets, that number is not expected to rise quickly. Hundreds of millions of Africans, eastern Europeans and Asians are at risk and could benefit from prophylaxis, but that would cost tens of billions of dollars."
In an article in the Washington Post
about the response to the epidemic, the authors note that aid from wealthy countries for HIV treatment is declining, and less than half of infected patients are covered by current funding levels.
The LA Times article
also notes the worrying result that drug resistance was seen in participants that began the study with undetected HIV.