A Massive HIV Breakthrough


One suspects that the news that a single drug can drastically lower the chances of getting infected with HIV may not receive the attention it deserves. Tenofovir-Emtricitabine or Truvada is an old drug, well-established and not on the cutting edge any more. But it's the first drug that, if taken by HIV-negative men, has now been proven to help prevent HIV infection. Why? Because the drug - used to treat people already infected with HIV - presents enough obstacles to new virus entering the body's CD4 cells that infection fails to take place:

In the study, published Tuesday by the New England Journal of Medicine, researchers found that the hundreds of gay men randomly assigned to take the drugs were 44 percent less likely to get infected than the equal number assigned to take a placebo. But when only the men whose blood tests showed they had taken their pill faithfully every day were considered, the pill was more than 90 percent effective, said Dr. Anthony S. Fauci, head of the division of the National Institutes of Health, which paid for the study along with the Bill and Melinda Gates Foundation.

“That’s huge,” Dr. Fauci said. “That says it all for me.” The large study, nicknamed iPrEx, included nearly 2,500 men in six countries and was coordinated by the Gladstone Institutes of the University of California, San Francisco.

This could have real implications especially in those subcultures where using condoms is rare, where the closet or the DL make any candid discussion of HIV before sex taboo.

It is a form of protection “that does not involve getting permission from the other partner, and that’s important,” said Phill Wilson, president of the Black AIDS Institute, which focuses on the epidemic among blacks.

But it can also provide a safety net for those who have a lapse, or an accident, or all those other ways in which sexual desire overwhelms judgment, especially among young men whose hormones are surging.

People understandably have been fixated on a vaccine. For many reasons, a vaccine for a super--sophisticated retro-virus that is constantly mutating has always been extremely hard. But if you combine combination therapy for those infected with prophylactic use of Truvada for those uninfected, you could sharply cut new infections. And such sharp cuts in infection rates can turn an epidemic into something much rarer.

This is the best news in a very long time - alongside the recently developed vaginal microbicide - because it empowers people to protect themselves in ways that do not involve any action before or during sex, when one's judgment is most impaired.

(Photo: Scanning electron micrograph of HIV-1 budding (in green) from cultured lymphocyte. This image has been colored to highlight important features. Multiple round bumps on cell surface represent sites of assembly and budding of virions.)