The problems with just slapping together an article on PrEP and not looking at facts #HIV #AIDS #PrEP
I scour the internet daily looking for things to share, and as of late the gay news cycle is tedious, repetitive and boring as hell. I find no need to litter the internet with my take on articles that appear on 17 other sites, so I leave them be. You can read those retreads over there, thanks. Until things perk up out there, I’m sticking on other subjects – in particular PrEP. This past week, a major French study broke news that they were having so much success with their results that they were offering Truvada to all participants:
IPERGAY’s early closure is significant not only because it adds confirmation that PrEP can be highly effective, but because it was testing an innovative, intermittent (“on-demand”) PrEP regimen. In this study, participants did not take PrEP daily, but only when they anticipated having sex. The regimen involved taking two pills of Truvada (tenofovir + emtricitabine) in the 24-hour period before anticipated sex and then, if sex happened, two separate one-pill doses in the two days following sex.* This extends the versatility of PrEP and provides an alternative regimen to daily dosing.
IPERGAY was run by the French national AIDS research institute, ANRS, and began in February 2012. It randomised gay men at high risk of HIV infection to the Truvada regimen or to a placebo – a protocol that caused some controversy among activists who felt studies such as iPrEx had already demonstrated that PrEP worked. All participants were also offered a package of measures including “personalised and frequent” counselling, repeated HIV testing, screening and treatment for other sexually transmitted infections, hepatitis B vaccination, condoms and lubricant. At the time of closure of its randomised phase, the trial had approximately 400 participants.
Following the decision taken by the PROUD study investigators to give daily Truvada to all its participants, ANRS urgently contacted the IPERGAY trial data safety monitoring board (DSMB) for a review. The DSMB examined the unblinded data and found a significant difference in incidence between the two groups with a “very significant reduction” in the risk of HIV infection in the PrEP group, which a press release describes as “much higher than the one observed in the IPREX trial” (as is the case with PROUD). The DSMB therefore recommended that all trial participants were offered Truvada, taking it “on demand” as in the trial.
As with PROUD, no actual effectiveness figure or other quantitative data were released, pending full analysis of the figures. The full results should be available early in 2015.
The trial will continue in non-randomised form for at least a year, as will PROUD, because of the need to demonstrate that “on demand” PrEP can have long-term benefit and to gather data on safety.
Great news, right? Predictably, plenty of gay web sites took the same article and slapped a few introductory sentences on it and hit the publish button. No investigation or fact finding required. While I have to get credit in the right place for Americablog and Dr. Mark Thoma for even getting articles out there, as usual I have problems with the content.
- Right off the bat, the title, “Prevent HIV with just four pills?” How does that read to you? “The cure for HIV is just four pills away”?. “You’re completely bulletproof after just four pills against HIV”? Yeah, it’s borderline click-bait in my opinion.
- Thoma does an OK job of capturing the AIDSMap information around the IPERGAY article, but then he goes right off topic in stating his concerns with it, leading with the fact that very few men are actually taking it. Given that there’s so much misinformation out there on the subject (including in this piece) why would they bother to take it?
- Taking a pill a day is “inconvenient? Thoma cites a study (without linking to it) that guys are avoiding PrEP because taking a pill a day is an undue burden. Really? Who ARE these guys that can’t add take a pill to their normal routines? Brush your teeth, wash your face, pop one pill a day down the hatch – easy peasy. I’ve been a participant in two NIH sponsored studies and am now a full time Truvada user. The number of doses I’ve missed? Zero.
- Thoma also brings up an interesting point on the idea of a subcutaneous Truvada, but at this point it’s just academic. There is no known study
- Truvada is expensive: No, no, no it’s not. This fact hit the internet when Truvada and PrEP first came out and it’s the biggest wives tale out there. I pay absolute zero for my monthly prescription and I never have. My insurance picks up part of the tab and Gilead picks up the rest.The same applies to those without insurance. The bottom line is that if you want to get on PrEP, there is no reason why you can’t get on it. When I got on Truvada after the medical trials, my MD gave me my copay card right on the spot. One phone call, no waiting and I had the prescription that day.
- PrEP and Truvada might be denied by some right wing corporations and their insurances. Never happened, never will. Even citing this as a possibility is akin to saying you wouldn’t go outside because you fear the possibility of getting hit by a stray piece of the international space station re-entering the atmosphere and killing you. Not out of the realm of possibility, but not bloody likely either.
PrEPWatch.org is a one-stop shop for everything PrEP – from dosing information for clinicians to how to pay for it, to all the studies out there on the subject. They track any problems with getting PrEP, as well as help those doctors out there that haven’t a clue how to prescribe it and they’ve also made a big difference in insurance companies getting on board with paying for it. The logic behind any insurance company paying for PrEP is a no-brainer: it’s more cost effective to pay for Truvada and keep the patient healthy than run the risk of their becoming positive and the lifetime of possible health concerns.
The bottom line is this: when you’re reporting on HIV/AIDS and PrEP, you have to do far, far more than just repeat an article and add a few anecdotes. There’s so much misinformation out there on Truvada and PrEP, it’s not going to make the gigantic leap forward that condoms did in HIV prevention until it gets a serious PR makeover. Sites like PrEPWatch and a few others – like mine – aren’t nearly as visible as they wish they could be in order to make this happen.