Understanding iPrEx Results
On November 23, a global PrEP study released it's findings on whether a pill a day could prevent HIV transmission among gay and bisexual men. The results could be a game changer.
Taking a once daily dose of Truvada, an antiretroviral drug, reduced the chances of HIV infection by 44%, according to the results from an oral PrEP study in HIV negative gay and bisexual men and transfemales. For those who took the medication very consistently, efficacy climbed to 74%.
STOP AIDS joins in the celebration, extending thanks to all the study participants and those who contributed to this groundbreaking moment. This is the first HIV prevention randomized control trial to prove successful for men who have sex with men and transfemales.
An important caveat
These results were achieved during the course of a clinical research trial. In addition to getting medication, participants received monthly risk reduction counseling, monthly HIV & STD tests, access to free condoms and hepatitis B vaccinations. Also, if someone reported a potential exposure to HIV that met the threshold for PEP, they were immediately switched to a PEP regimen.
The researchers’ results must be understood within this clinical context. It would be a mistake to attribute all of the success to the pill itself.
PrEP works only if you take it
Another key finding was that the level of protection was closely tied to how consistently the medication was taken. Those who took it everyday, or nearly everyday, appeared to have enough of the drug in their system to protect them at much higher levels. Those who took it less frequently didn’t get the same levels of protection.
The study medication needed to be taken once a day to achieve high levels of protection – not just the night before sex, immediately before sex, during sex or after sex. Currently, there is no data to indicate that these drugs will work if taken intermittently.
PrEP works only if you’re negative
The dosage used in the study is also not enough to adequately treat an HIV infection. In fact, if someone HIV positive were to take a PrEP dosage of these antiretroviral medications, they could risk developing a drug resistance.
For PrEP to work, someone must get an HIV test before they begin, preferably an RNA test that can detect the virus, not just the antibodies. They will also need to get tested on a routine basis: study participants got tested every 30 days.
Access & Availability
Today’s results open up big questions about how and when people in need will get their hands on PrEP. Currently, the only legal option is to find a physician willing to prescribe it; however, since insurance companies won’t pay for it, the individual would need to pay for it out of pocket.
Obviously, this is an unacceptable long-term strategy. Our goal is to work toward equal access for everyone in need across the globe.
These study results are very promising -- there was an air of excitement in the room as the results were presented in San Francisco. There was a distinct sense that the community had come together to make something great happen. While much remains to be seen about PrEP access and how it gets integrated into our community, there is hope that this new prevention tool can help change the tide of new infections in San Francisco and around the globe.
Full study results
more articles about PrEP research