AIDS Experts Applaud Scientific Advances, Call for Increased Support of Prevention and Treatment Programs
November 23, 2010 - WASHINGTON - All eyes are on prevention this World AIDS Day (Dec. 1). Every year, 2.7 million people worldwide are newly
infected with HIV, while only about one-third of HIV patients in poor countries who meet criteria for treatment have access to it. This highlights the urgent need
for new and creative prevention tools that go beyond safer-sex counseling and condom promotion.
Today The New England Journal of Medicine released the positive results of the Pre-exposure Prophylaxis Initiative (iPrEx) trial, which
looked at whether daily oral dosing of two FDA-approved antiretroviral (ARV) medications used to treat HIV/AIDS - tenofovir and emtricitabine combined in one
tablet (Truvada) - can prevent HIV transmission among men who have sex with men (MSM) who are at high-risk of infection. Trial investigators found that
daily dosing produced a 44 percent reduction in the incidence of HIV. A detectable level of the study drug in participants' blood strongly correlated
with the prophylactic effect, and was associated with a protective effect exceeding 90 percent. The study enrolled nearly 2,500 HIV-negative MSM at
11 locations across the globe, including Brazil, Ecuador, Peru, South Africa, Thailand and two locations in the United States. The average
trial participant was tracked for 1.2 years and received safe-sex counseling, condoms and treatment for sexually transmitted infections.
"The results represent the first demonstration that using oral medications that are already FDA approved before a risky exposure can decrease
the likelihood that MSM could become HIV-infected," said Kenneth H. Mayer, MD, Director of the Brown University AIDS Program and the Fenway Health iPrEx trial site
Principal Investigator. Dr. Mayer co-chairs the Center for Global Health Policy's Scientific Advisory Committee.
This announcement builds on the CAPRISA 004 trial results released earlier this year that found that a coitally-dependant, 1 percent tenofovir gel
applied topically reduced South African women's risk of acquiring HIV through vaginal sex by 39 percent. While more supporting data about effectiveness, adherence, and other
issues is still needed before this product can be made widely available, it opened a door in biomedical prevention research to use these powerful antiretroviral drugs as
a means of prevention.
"This challenges the global donor community to enable the application of pre-exposure prophylaxis to prevent HIV in the highest risk subgroups," said Sten Vermund,
MD, PhD, Professor of Medicine at the Vanderbilt University School of Medicine and a member of the Center's Scientific Advisory Committee. "It also challenges the
global research community to identify combination strategies to maximize the overall impact of all our prevention tools."
Despite these exciting advances, we still face significant roadblocks in combating HIV/AIDS, including the deadly combination of HIV and tuberculosis (TB). TB is the biggest
killer of those with HIV/AIDS in sub-Saharan Africa, and in Swaziland, a country with the highest HIV prevalence among adults in the world, life expectancy has dropped from
60 to 31 years during the past two decades due to HIV and TB. Interventions that decrease HIV transmission and HIV/AIDS - such as pre-exposure prophylaxis - should decrease
vulnerability to TB as well.
But we are not without interventions backed by good science that can save lives. A new observational study recently published in the journal AIDS supports the need for
early TB preventive interventions among people with HIV, finding that isoniazid preventive therapy (IPT) significantly reduces an HIV-infected person's chances of acquiring TB infection.
"And yet the treatment of HIV-infected patients with IPT in resource-limited settings is rarely employed," said Carol Dukes Hamilton, MD, Senior Scientist
of Health and Development Sciences at FHI and co-chair of the Center's Scientific Advisory Committee. "Early treatment and prevention have long shown that they are cost
effective and in some cases cost reducing in the long run." But securing the needed funds to act aggressively now to slow the burden of these diseases is proving
increasingly challenging, with the funding levels for the federal fiscal year that began on October 1 still uncertain.
Meanwhile, Washington is facing a sea change as we head into a new U.S. Congress with more than a hundred new members, and a new Republican-controlled House
of Representatives. A strong response to the HIV pandemic in the U.S. and the developing world has a long history of bipartisan support that must continue in the form
of resources to ensure life-saving prevention and treatment are available and implementation plans to ensure that scientifically tested and proven interventions reach those who need them the most.
The Center for Global Health Policy, established by the Infectious Diseases Society of America's Education & Research Foundation and the HIV Medicine Association
in 2008, supports and promotes U.S. efforts to combat HIV/AIDS and tuberculosis around the world. The Center provides scientific and policy information to U.S. policymakers,
federal agencies, nongovernmental organizations and the news media, linking decision-makers to the latest evidence-based input and guidance from physician/scientists and
other professionals from both developing and developed countries.
The Center for Global Health Policy is a project of the
Infectious Diseases Society of America and the HIV Medicine Association.
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