The medication used to prevent HIV infection, Pre-exposure prophylaxis (or PrEP), can now be taken as needed rather than daily, according to a new study. Researchers found that on-demand use reduced risk of HIV infection by 97 percent. The team also noted that while using the medication, more people opted not to use a condom, rising from 77 percent at the baseline to 86 percent.
Researchers enlisted 361 gay men for the study, which looked at whether taking PrEP before and after sex was as effective as using the medication daily. Participants previously took part in a clinical trial of the drug, which was prematurely stopped when researchers determined the medication was effective in preventing HIV. Though, researchers in this study note this could have skewed the results.
Because the treatment was so effective, "treatment for the placebo group in this trial was prematurely discontinued after a median follow-up of only 9·3 months; therefore, one cannot dismiss the possibility of an overestimation of PrEP efficacy in this study because of high initial adherence, and more data are needed to confirm the efficacy of PrEP on demand,” they write.
Reuters reports that the men took two doses of Truvada, the brand name of PrEP, up to 24 hours prior to sex, with a third dose coming 24 hours later and the final dose 24 hours after the third.
The team believes their research could help make the drug more accessible, saving consumers about 40 percent when using it as needed instead of daily. PBS reports that without insurance, the medication costs approximately $1,300 a month, though many insurance companies do cover part of the expense.
HIV and AIDS news site NAM says that more than 79,000 people have used the medication in the United States. It’s advised that people who are at high risk of being infected with HIV take the drug, which includes gay or bisexual men who engage in anal sex without a condom, intravenous drug users and heterosexual individuals who don’t always use condoms when having sex with high-risk partners. Although it’s been shown as effective in preventing HIV, PrEP does not guard against other sexually transmitted infections and is meant to be used in addition to condoms.
As PBS explains, public health officials originally believed there would be a huge demand for Truvada when it was released, however, it failed to garner enough support. Affordability and criticism over various factors may explain why PrEP isn’t more widely used. The AIDS Healthcare Foundation, a nonprofit, has been one vocal opponent to the medication as President Michael Weinstein believes daily use makes it an impractical solution.
“The bottom line is that people won't adhere and take the pill," he told BuzzFeed in 2014. "That's what studies have shown. If this catches on as a public health strategy, that means there are going to be people who will take Truvada irregularly and some will be infected, and some develop drug resistance."
However, advocates believe the life-saving benefits are worth the inconvenience.
"The research shows a majority of gay men are having bareback sex," Dr. David Hollan of Georgia Health Department, told Vice. "We are trying to make everyone's lives safer within that reality."