Kyle, a 29-year-old Sydneysider, never knew a time when HIV wasn’t a persistent and pernicious threat — until he began popping a pill to prevent it.
The blue, oval-shaped antiviral tablet, known as Truvada, that Kyle takes daily is the subject of a study in Australia’s New South Wales state that, in less than a year, has helped drive new cases of the AIDS-causing human immunodeficiency virus among gay and bisexual men to the lowest since 1985.
“It feels good to be a part of that,” said Kyle, a retail assistant who joined a program called pre-exposure prophylaxis, or PrEP, in January to ease his fear about being infected with HIV during sex on the occasions he doesn’t use a condom. “I do feel a lot safer.”
Thirty-six years after a rare lung infection in gay men in Los Angeles heralded the start of the AIDS epidemic in North America, the deadly disease is firmly in retreat globally. For the first time, more than half of all people living with HIV are on virus-suppressing treatment that staves off symptoms and prevents transmission. And thousands of people are using Gilead Sciences Inc.’s Truvada in the form of PrEP, curbing the spread in communities from London to San Francisco.
PrEP reduces the risk of HIV from sex by more than 90 percent if the pill — a fixed-dose combination of the drugs tenofovir disoproxil and emtricitabine — is taken daily. As cheaper, generic versions of Truvada made by Mylan NV, Cipla Ltd. and Teva Pharmaceutical Industries Ltd. become more widely available, doctors and public health researchers are testing its ability to slash HIV incidence in the developing world, especially sub-Saharan Africa, where it’s mostly transmitted by heterosexual sex.
Impact In Africa?
“The global epidemic is driven in eastern and southern Africa, and it’s driven predominantly among women,” said Mitchell Warren, executive director of New York-based advocacy group AVAC, which tracks more than 40 ongoing and planned PrEP studies across the world. “To really end the global epidemic, we have got to figure out if oral PrEP can have an impact in Africa like it can in other places.”
HIV diagnoses at the U.K.’s busiest sexual health center — London’s 56 Dean Street clinic in Soho — plunged 42 percent last year, and in San Francisco they have halved since PrEP was approved by the Food and Drug Administration in July 2012.
“You see this very dramatic decline in new infections that wasn’t seen just when we were treating people,” said Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne and a member of the International AIDS Society’s governing council.
Gilead counted 136,000 people taking Truvada as PrEP at the end of the second quarter, compared with 60,000 to 70,000 a year earlier. That’s still a fraction of the 1.2 million American adults at significant risk of becoming HIV-positive who researchers at the Centers for Disease Control and Prevention say are candidates for the regimen.