Inter Press service examines research into PrEP

Inter Press Service last week examined how researchers are investigating the use of antiretroviral drugs as a possible method of pre-exposure prophylaxis. AIDS Vaccine Advocacy Coalition's Executive Director Mitchell Warren recently said that such efforts are "a pivotal moment in HIV/AIDS research."

Mitchell -- who was speaking at the Fourth South African AIDS Conference -- said, "We are at a time where prevention and treatment need to marry." Salim Abdool Karim, director of the Centre for the AIDS Program of Research in South Africa, said that PrEP is "biologically plausible" and that the method "could prevent millions of new infections every year." Inter Press Service reports that there are three PrEP trials planned by different research organizations worldwide that aim to examine preventing the heterosexual transmission of HIV among women.

Abdool Karim said that a large-scale, antiretroviral-based prevention campaign could face several questions, including the safety of giving HIV-negative people chronic medication, the possibility of drug resistance and the frequency of testing for people on PrEP. Francois Venter, head of the HIV management cluster of the Reproductive Health and HIV Research Unit at the University of Witwatersrand, said that if people on PrEP are tested annually and if those who test positive are placed on care "immediately," there is a "very good chance to lower transmission rates" and "decrease prevalence of the actual disease."

Additionally, Venter said an antiretroviral-based prevention strategy can drastically reduce hospital spending on opportunistic infections like tuberculosis. According to Venter, the use of PrEP is "like a huge elephant in the room because it is a huge controversy." Some critics of the idea argue that it will undermine existing prevention efforts. Nomfundo Eland, national program manager for the Treatment Action Campaign, said antiretroviral-based prevention "is very promising" but needs to be combined with other prevention strategies.

Venter said that it is necessary to move away from "feel-good" prevention messages, such as "be faithful," and focus on science-based prevention programs, such as antiretrovirals. Abdool Karim said that "most of the existing prevention methods are not an option" for young women, who represent the fastest growing population of HIV-positive people. Campaigns like abstinence, faithfulness, male circumcision, condom use, and voluntary counseling and testing do not "fundamentally address the vulnerability of young women," Abdool Karim said (Palitza, Inter Press Service, 4/1).