Dec 08, 2010

Good News on World AIDS Day. Sort of.

by Laura Starita

In the lead-up to World AIDS Day last week, the New England Journal of Medicine reported results from a drug trial which showed that using the AIDS drug Truvada as a once-a-day prevention protocol produced a 43 percent reduction in infections among the entire cohort of gay men in the study’s treatment arm. When researchers considered only those who took their medicine every day (as determined by blood samples) effectiveness rose to 90 percent.

It is rare to hear good news in HIV/AIDS prevention. More often, health experts lament the fact that advances in treatment cannot keep up with increases in new infections. So this study does offer some good news, joining a March report about a gel-based microbicide that was between 39 and 54 percent effective at preventing infection in women—together the results from these two studies offer the only bright lights in HIV prevention in a long time.

Now comes the not-so-good part: The annual cost of taking Truvada once a day is $12,000 per person in the United States; in a health system already struggling to contain costs, such a high price tag would surely be met with payer resistance. Cheaper generics are available in the developing world, which would bring the cost down, but they will never be cheap for poor countries, particularly not for places such as eastern and southern Africa, where the epidemic is generalized to the entire population. Another challenge? The study participants were gay men, making effectiveness results un-applicable to women, who represent the majority of people living with HIV/AIDS in Sub-Saharan Africa. In a number of countries (Mozambique, Zimbabwe, Kenya, to name a few) young women are as much as seven times more likely to contract the disease than their male peers.

So, it is great news that there seems to be a pharmaceutical solution, but it is hard to get excited about a $12,000 option when the world’s public health system still hasn’t managed to get $2 vaccines or deworming medications to all the people who need them (In other news of financial limitations, UNAIDS has reportedly been having trouble raising the money for a second trial to confirm the results of the microbicide, a much less expensive option). Next up? How about an option that not only works, but that people at risk can actually use.