I’m not sure why we are so uptight about prophylaxis to prevent infection. As Prof Joop Lange has pointed out, it’s something which has been around for many years. When I was in the military in Malaysia (many years ago), we were required to take a daily paludrine to prevent malaria. I think paludrine has long since been replaced as a result of resistance, but folk in malarious areas still take prophylaxis.

Further, we’ve been using cotrimoxazole prophylaxis among ‘healthy’ PLHIV for many years now to prevent PCP and other nasties. And of course, perfectly healthy women take ‘the pill’ every day…

It is true there is a risk of writing off a good ARV by using it for prophylaxis (as perhaps we did with paludrine). If people unwittingly become infected but continue to take the drug, they are effectively taking monotherapy, which will quickly result in resistance to the drug. (This is the fear which is preventing more widespread use of another form or ‘standard’ prophylaxis, that of isoniazid to prevent TB.) Tenofovir is a very important element of our anti-HIV armamentarium, and were we to lose it to widespread resistance, it would be a major blow. To counter this, Prof Lange has suggested (without much hope, it seems) that we should reserve one ARV for prophylaxis and not use it in treatment.

Final point: the British used to refer to condoms as prophylactics; don’t know if they still do, but exactly the same comments apply here. “Do we really think that HIV negative people will be sufficiently motivated” to use condoms? I think we know the answer. But a pill may be easier, can be taken be the woman, perhaps even added to her daily pill?

Chris