Can A Pill A Day Prevent HIV?

As medical students, the threat of needle-stick injuries and the subsequent use of Post-Exposure Prophylaxis (PEP) is a constant looming presence. Side-effects are sucky, viral resistance is sucky, HIV is sucky.

I don’t know how I missed it, but apparently there have been some significant trials for pre-exposure prophylaxis (PrEP). The article I found can be read here, and the original paper published in the NEJM is available on Google Scholar.

What it comes down to is that the trials were done with cohorts of men who have sex with men and/or transgender women who have sex with men. They were given Truvada, which is a combination ARV of Emtricitabine and Tenofovir. These are both Nucleoside Reverse Transcriptase Inhibitors and they basically inhibit replication of the HI-virus.

The study basically found that PrEP lead to a significant reduction in HIV-contraction. Which is awesome.

But what I want to know, is how does that work, physiologically? If NRTIs prevent viral replication, how can it be considered to be true PrEP? Truvada is often given as PEP. So, perhaps, it’s still just PEP, given before the risky event occurs. But doesn’t this kind of continuous ARV administration bring about a risk for resistance if the person does acquire HIV?

There are some costs attached to PrEP, as with any drug. Which makes it quite likely that the rich will be able to afford it and the poor… will have to stick with condoms.

I want to know about side effects: Truvada has them. Lots of them. But different people react differently to them, as with any drug. Would this be a viable option for medical professionals? Would it be worth it, for medical professionals?

And why on Earth did I only hear about this now?

As always, I’d love to know your thoughts on this – whether you are gobsmacked with me, or you actually have answers to my confusion.

2 thoughts on “Can A Pill A Day Prevent HIV?

  1. I have heard that pre-prophylaxis is a theoretical possibility, but I too have never seen research on it or had anyone mention it as more than a theoretical possibility. Interesting.

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