Truvada: The new morning before and after pill?

The scientific community and HIV/AIDS activists are abuzz about the preliminary findings of a new PrEP study showing not only the effectiveness of the treatment overall, but the success of an innovative regimen wherein participants took PrEP only when they anticipated having sex instead of taking it daily as it is currently prescribed.

Participants in the IPERGAY trial, which occurred in France and Canada and closed early due to high effectiveness, took two pills of Truvada in the 24-hour period before anticipated sex and, if sex occurred, then took two separate one-pill doses of the drug in the two days following sex. IPERGAY investigators did not release any effectiveness figures or other data, but will do so once a complete analysis of the results has been completed, which they say should be sometime in early 2015.

HIV/AIDS activists in Atlanta are cautiously optimistic.

“I think it’s significant. It adds a way of protecting those who are at high risk, especially MSMs who are sexually active,” said Ronnie Bass, executive director of HIV/AIDS outreach organization Someone Cares, who also warns, “It’s not a Band-Aid toward having unprotected sex, it’s not a quick fix.”

Craig Washington of AID Atlanta. (file photo)
Craig Washington of AID Atlanta. (file photo)

Other activists echo Bass’s sentiments.

“I think it’s very significant and I think the potential benefits outweigh the risk of disinihibition in terms of condom use,” says Craig Washington, prevention programs manager at AID Atlanta, who intend to provide PrEP within the next few months. “PrEP is shown to be effective, now even moreso.”

Michael Baker, director of advancement at Positive Impact, wants more information.

“We think it looks real promising, but we will need to look at the details once more information comes out. There are a lot of if’s,” he says. “As far as our clinic goes, we will have to adhere to whatever the CDC is advising. I will tell you the CDC is moving very strongly in the direction of PrEP.”

The U.S. Public Health Service released new federal PrEP guidelines in May, developed by a working group led by the CDC, which recommended PrEP for people who are at a substantial risk for HIV, including gay and bisexual men.

The announcement led to criticism from Michael Weinstein, president of the AIDS Healthcare Foundation, who has called PrEP “a public health disaster in the making” and Truvada a “party drug.” This week, Weinstein’s organization launched a national advertising campaign in LGBT media using the headline “What if you’re wrong about PrEP?” The group has also sent press releases about the campaign to LGBT media organizations across the country, including the GA Voice.

However, Weinstein doesn’t appear to have many allies on this issue. HIV/AIDS groups across the world, including here in Atlanta, have blasted him for his comments.

“I think it’s really unfortunate to have someone in his position to make the comments he’s making,” Baker said. “I’ve read the same studies and they say the exact opposite of what he’s saying. I think he’s doing the community a major disservice by not backing up his claims. From Positive Impact’s position, we don’t believe in sex shaming.”

AID Atlanta’s Washington has even stronger words for Weinstein, saying, “We don’t have the luxury of being distracted or having our mobilization on PrEP complicated by his unfounded protests that are just not based on science. That’s part of what frustrates and angers me.”

“Our community has the highest infection rates and yes, the mortality rates are not what they were 10 or 15 years ago but people are still getting sick and still dying and still becoming infected,” he continues. “So we have to maximize this tool, as well as getting more gay men virally suppressed. We don’t need the ramblings of zealots to distract us. It’s crazy.”

In the meantime, in the wake of this latest study, the CDC is taking a wait-and-see approach.

“It is important to point out that while these announcements are encouraging, at this point we do not have any data or other critical details from these trials,” said Dr. Eugene McCray, director of the CDC’s Division of HIV/AIDS Prevention, in a statement released shortly after the findings were announced.

“More specifically, we have no data on factors that may have informed these announcements including rates of HIV infections, PrEP adherence or risk behaviors among trial participants. We also do not yet know what IPERGAY will tell us regarding the frequency, timing, or exact dose of PrEP required for protection.”

The IPERGAY trial will continue in non-randomized form for at least another year to gather safety data and show that “on demand” PrEP can have long-term benefits.

The CDC urges gay and bisexual men and other groups at higher risk of HIV infection to continue to follow current CDC guidelines, which recommend the FDA-approved regimen of daily oral Truvada for HIV prevention. | @patricksaunders