Two weeks ago, the FDA made waves in reproductive health by approving a new HPV screening test.This week, the CDC had a turn at shaking things up by recommending a pill to prevent HIV.
Similar to the HPV test, the new CDC guideline makes official a new use for something that has been around for a while. In this case, it’s Truvada, an antiretroviral drug with few side effects that most insurance companies already cover. These facts make it an appealing option, and may explain why no other antiretrovirals were recommended for prophylactic use. It will be interesting to see if any of the similar drugs are eventually recommended as well.
The official guideline states that pre-exposure prophylaxis (PrEP) regimen should be used only in conjunction with condoms. The CDC also recommends that this regimen, which requires taking Truvada daily, should be considered for people at high risk of infection, including:
- men who have sex with men (MSM) without condoms
- people who have sex with high-risk partners, such as drug injectors or MSM who have sex without condoms
- people who regularly have sex with anyone they know to be HIV-positive
- anyone who shares needles or injects drugs.
The guidelines make two additional recommendations:
- 1) Patients should get an HIV test before taking the drug.
- 2) Patients should be tested for STIs every three months.
These two recommendations make it clear that the CDC recognizes some individuals will use PrEP in lieu of condoms rather than in addition to them. The goal is obviously to catch and treat other STIs as quickly as possible as well as to monitor HIV status. Though Truvada is often used as part of HIV treatment, the therapeutic dosage is much higher compared to that used for PrEP.
The CDC’s decision comes at a critical time. While HIV infection rates have remained relatively stable over the past 30 years, condom use is on the decline. That being said, not all health care providers are on board with the new recommendations. Many feel this move will only lead to further decreases in condom use among the highest-risk populations as well as corresponding increases in rates of other STIs. Other barriers to widespread acceptance of Truvada for PrEP include the lack of advertising by its manufacturer, stigma associated with its use, and a dearth of knowledge among general practitioners about this use.
This new drug regimen begs comparison to birth control pills. Though more effective than condoms alone, we know that the oral contraceptives are quite as effective as they could be, thanks to human forgetfulness, error, and the day-to-day struggles that can make taking a pill daily difficult. There are many things about how PrEP is implemented that will be important to watch, namely whether it will gain widespread acceptance among intended users, and how they actually use it.
Other Sexual Health News this Week
Texas Bill Requiring Sex Education Dies in Committee (Houston Chronicle)
Transgender Controversy Reopens Louisvile Schools Discrimination Debate (Courier-Journal)
Labs Are Told to Start Including a Neglected Variable: Females (New York Times)
The following conferences are taking place in May and June. Click on each title for more information and to register.