Gilead Sciences, Inc. (Nasdaq:GILD) today announced that the U.S. Food
and Drug Administration (FDA) has approved once-daily oral Truvada®
(emtricitabine and tenofovir disoproxil fumarate), in combination with
safer sex practices, to reduce the risk of sexually acquired HIV-1
infection in adults at high risk. Truvada is the first agent to be
approved for HIV prevention in uninfected adults, a strategy called
pre-exposure prophylaxis (PrEP). As part of the approval, Gilead worked
with the FDA to develop a Risk Evaluation and Mitigation Strategy (REMS)
to help ensure safe use of Truvada for PrEP as part of a comprehensive
prevention strategy. Truvada was originally approved in 2004 in
combination with other antiretroviral agents as a treatment of HIV-1
infection in adults and is currently the most-prescribed antiretroviral
product in the United States.
"Today's decision is the culmination of almost 20 years of research
involving investigators, academic and medical institutions, funding
agencies and nearly 20,000 trial participants around the world, and
Gilead is proud to have been a partner in this effort," said Norbert
Bischofberger, PhD, Executive Vice President, Research and Development
and Chief Scientific Officer, Gilead Sciences. "This advancement in the
field of HIV prevention was made possible due to the leadership and
commitment of the FDA and the Department of Health and Human Services to
reduce the number of new HIV infections in the United States and
It is estimated that 1.2 million Americans are currently living with
HIV, and, despite the availability of existing prevention tools such as
condoms, the incidence rate has remained steady over the past two
decades with approximately 50,000 new infections occurring each year.
Nearly one-quarter (23 percent) of new HIV cases occur among women, and
more than half (61 percent) occur among men who have sex with men (MSM).
In particular, young African American MSM bear a heavy burden of the
epidemic, with new HIV cases among this group increasing by nearly 50
percent between 2006 and 2009.
Data supporting the approval of Truvada for PrEP came primarily from two
large placebo-controlled trials known as the Pre-Exposure Prophylaxis
Initiative (iPrEx), sponsored by the U.S. National Institutes of Health
(NIH) and the Bill and Melinda Gates Foundation, and Partners PrEP,
sponsored by the University of Washington and funded by the Bill and
Melinda Gates Foundation. The iPrEx and Partners PrEP trials found that
Truvada reduced the risk of acquiring HIV infection by 42 percent and 75
percent, respectively. Several other clinical studies also support the
use of Truvada for HIV risk reduction.
"This approval is a major milestone in our 30-year fight against AIDS,"
said Robert M. Grant, MD, MPH, Betty Jean and Hiro Ogawa Endowed
Investigator, Gladstone Institute of Virology and Immunology, University
of California, San Francisco and lead investigator of the iPrEx trial.
"The use of PrEP alongside routine HIV testing gives us a tremendous
opportunity to reduce the rate of new HIV infections in this country and
around the world."
Based on the iPrEx results, in January 2011 the Centers for Disease
Control and Prevention (CDC) issued interim guidance on Truvada as PrEP
among high-risk adult MSM. CDC is currently developing formal U.S.
Public Health Service guidelines for the use of PrEP among both men and
women, which will address procedures for HIV testing and health
screening prior to PrEP initiation, as well as ongoing monitoring for
cases of HIV infection that may occur despite PrEP use, possible drug
resistance among those who become infected, side effects and clinical
"The data clearly demonstrate that Truvada as pre-exposure prophylaxis
is effective at reducing the risk of HIV infection acquired through
sexual exposure," said Connie Celum, MD, MPH, Professor of Global Health
and Medicine at the University of Washington and lead investigator of
the Partners PrEP trial. "It is exciting to consider the potential
impact of this new HIV prevention tool, which could contribute to
significantly reducing new HIV infections as part of a combination HIV
prevention strategy. Although the implementation of PrEP will bring
challenges, they can be anticipated and systems developed to address
these challenges. In particular, systems to provide comprehensive
education and support to health care providers and people who use PrEP
will be required to ensure appropriate and effective use of this
potentially groundbreaking new HIV prevention intervention."
As part of the REMS developed by Gilead and FDA to ensure safe use of
Truvada for PrEP, Gilead has developed FDA-approved materials to educate
and inform healthcare providers and uninfected individuals about Truvada
for PrEP. These materials highlight the importance of strict adherence
to the dosing regimen, emphasize that Truvada must be considered as only
one part of a comprehensive prevention strategy to reduce the risk of
HIV-1 infection and convey that Truvada for PrEP should only be used in
individuals who are confirmed HIV negative and HIV-1 screening should be
repeated at least every three months while taking Truvada for PrEP.
Truvada for PrEP should not be initiated when clinical signs or symptoms
consistent with acute HIV-1 infection are present.
As a separate measure to support the safe use of Truvada for PrEP,
Gilead also will provide vouchers for free HIV testing and condoms, an
opt-in service for regular reminders about HIV testing and subsidized
HIV resistance testing for any individual who becomes HIV-positive while
taking Truvada for PrEP.
In all studies of Truvada for PrEP, the most commonly reported side
effects included headache, stomach discomfort and weight loss. The
incidence and types of side effects were consistent with Truvada's
safety and tolerability profile when used as an HIV treatment, which is
supported by more than four million years of patient use. Overall, there
have been nearly nine million patient years of experience with
Source: Gilead Sciences, Inc.