Monday, December 1, 2008

Can HIV Infection Be Prevented with a Once-Daily Pill?

(The following article is included in the World AIDS Day issue of Scientific American, along with articles on circumcision and microbicides.)

Once the bane of global activists and politicians in developing nations, pre-exposure HIV preventatives are being tested in AIDS-stricken Africa

By Nicole Itano
JOHANNESBURG, SOUTH AFRICA—Nearly four years after political pressure shut down two trials that would have tested whether a once-a-day pill could prevent high-risk HIV-negative people from catching the AIDS-causing virus, there’s a surge of renewed interest in the concept, known as Pre-Exposure Prophylaxis, or PrEP.

Western doctors and organizations that funded the halted trials of the anti-HIV drug tenofovir in Cameroon and Cambodia say they've learned their lesson from the debacle in 2004 and 2005, when activist groups questioned the quality of medical care impoverished study participants would receive if they suffered side effects or the became infected by HIV. Today, with at least seven U.S.-funded PrEP trials underway at a cost of $39.5 million, researchers are working with local advocates, who have traditionally been distrustful of Big Pharma, to push the studies forward.

"The whole prevention community really had a wake-up call," says Linda-Gail Bekker, an infectious disease researcher at the University of Cape Town’s Desmond Tutu HIV Center, who is running the South African study site for a new PrEP trial that will eventually involve at least 3,000 gay men in South Africa, Asia, South America and the U.S. The study, which is enrolling trial participants now, is being funded by the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation. Its first results are expected in 2010.

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