23/01/08

A viagra, half an E, some ARVs: the new party pack?

So if you give antiretrovirals to humanised mice (don’t ask) and then slosh their vaginas full of HIV, they don’t get infected, according to a new study from Paul Denton and colleagues at the University of Texas. None of the five mice treated with a combination of emtricitabine and tenofovir got infected, whereas 7 out of 8 mice that weren’t injected with ARVs before their simulated sex contracted HIV.

These results, published in the wonderful, open access Public Library of Science, will encourage those who think we can shut down HIV by doling out drugs to uninfected people before they get exposed to the virus — pre-exposure prophylaxis, or PrEP in the industry jargon. This stratgey is currently being tried in four countries, and you can find out a lot more about it on the very informative Prepwatch site.

A number of mathematical models have shown that this strategy is a good idea from the point of view of public health authorities and taxpayers. The most recent of these, which makes good bedtime reading for higher-order modelling nerds, concludes with this very important sentence: “PrEP can be a cost effective intervention given high efficacy, good adherence and long-term use, especially if sexual disinhibition is prevented.” Which is rather like saying that Elizabeth Pisani can make a fortune as a model, given her height, long blonde hair and great tits, especially if she wears short skirts. The tragedy is that the first three are not given, and the third is so unlikely that you can pretty much discount it. A lot of the reason people don’t use the (cheaper, safer) prevention options already available to them, things like condoms, is not because they can’t (pace Time and others who endlessly reheat the “women are innocent victims” line.) A lot of the people who don’t use condoms don’t use them because they don’t like them, because they are too lazy, or because they are in denial about being at risk. (My husband? He goes to church, he wouldn’t sleep around!). Do we really believe uninfected people are going to do better with toxic drugs than they do with latex?

I confess that I am a bit old-fashioned about spending tax money on expensive, toxic pharmaceuticals to give to people so they can go out and do stupid things for fun. And if I feel that way about it (I who am perfectly happy spend tax money on clean needles and methadone for drug injectors, on free condoms and STI treatment for anyone that needs them), I’ve got a pretty good guess how it will play with the rest of the electorate.

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This post was published on 23/01/08 in Ideology and HIV, Pisani's picks, Science.

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  1. Comment by Tom, 23/01/08, 06:02:

    I agree that there can be no assumption that a chemical prevention is better than a jonny. I suspect that condom use is in itself habitual and people are either users or not. If that is the case if their is an alternative habit, consuming antiretrovirals, it maybe some people would prefer it (choice is good). and maybe pill poppers maybe better atthat sort of regular habitual use than condom use. And perhaps they will be better at not forgetting than the regular condom users, who probably still forget (?) from time to time.

    But before you shout and lose your temper, (too late) I accept that my habituals are not the real problem demographic. But to increase the number and variety of people doing the right thing will increase the peer pressure against those doing the wrong thing.

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