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Elizabeth Boskey, Ph.D.

Pre-Exposure Prophylaxis

By November 29, 2010

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I know I should be more excited about last week's news announcements on the efficacy of pre-exposure prophylaxis(PreP), but I'm still not blown away by the idea. Don't get me wrong, I think it's great that we have evidence that a drug regimen can reduce HIV risk in gay men, but I'm not convinced it's the most practical option for widespread prevention. Antriretroviral drugs are expensive, they can have significant side effects, there are concerns about drug resistance in people who are unknowingly HIV positive when they start PreP, you have to be good about taking them consistently for them to work, and they're still not as effective as condoms at preventing HIV.

The truth is, I'd be more excited about this study if people were discussing it differently. However the fact that people are so hyped on the concept of a pill that might be able to prevent HIV that they can't be bothered to mention that we do, currently, have other effective methods of HIV prevention (e.g. condoms, clean needles, etc.) really bothers me. Particularly since this was one study of one drug in one population, and we already know that prevention techniques that work in gay men don't always translate to heterosexuals and vice versa. In my opinion, right now, pre-exposure prophylaxis is, if anything, just another tool for the prevention toolbox - and a problematic one at that. Lets save our excitement for when we have a bit more data... and try and inject it with some realism. I have significant doubts about whether the vast majority of high risk individuals are going to be able to practically, or financially, stick with a PreP regimen.

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Comments
February 4, 2011 at 8:38 pm
(1) Pete says:

Due to an accident I was at risk of HIV as well and have been on the PEP for 17 days now. It is a perfect option for people who did not put them self at risk on purpose (like me) but seriously, the side effects are that bad that no one would want to go through this again. I have been severely unwell for 7 days with vomitting, diaoreah, vision impairment, cold sweats and timbering, dizzyness, hanuzination, loss of memory, extreme muscle twinching, extreme sensibility to noise, and general exhaustion and tiredness. I still am very sleepy and can sleep 24/7 despite normally being an early waker. The doctor said I was very unlucky having such a long list of side effects but nausea which is quite common when taking this medication is bad enough and as I said I think nobody chooses unwellness to unprotected sex therefore I’m please that the pep was invented!

February 6, 2011 at 8:24 pm
(2) std says:

Pete,

Thanks for sharing your experience! I do want to mention that the kind of treatment you’re describing is post-exposure prophylaxis, a very different animal from pre-exposure. I have no qualms about post-exposure prophylaxis being a useful tool.

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