U.S. signals shift in AIDS prevention

CDC recommends daily pill to help prevent infection

Officials at the U. S. Centers for Disease Control and Prevention recommended Wednesday that hundreds of thousands of Americans at risk for AIDS take a daily pill that has been shown to prevent infection with the virus that causes it.

The CDC’s advice could transform AIDS prevention in the United States — from reliance on condoms, which are unpopular with many men — to a regimen that relies on an antiretroviral drug, Truvada. It costs $13,000 a year, and most insurers already cover it.

The guidelines tell doctors to consider the drug regimen, called prep, for pre-exposure prophylaxis for gay men who have sex without condoms; heterosexuals with high-risk partners, such as drug injectors or bisexuals; patients who regularly have sex with anyone they know is infected; and anyone who shares needles or injects drugs.

Advocates for PrEP were elated at Wednesday’s announcement.

“This is wonderful,” said Damon L. Jacobs, a therapist who has been on the regimen since 2011 and has a Facebook page promoting it. “When an institution like the CDC makes a statement, it makes a profound difference to the doctors who are ambivalent.”

While many antiretroviral drugs could, in theory, be used for PrEP, the only pill approved for that purpose by the U. S. Food and Drug Administration is Truvada, made by Gilead Sciences. Truvada, a mix of tenofovir and emtricitabine, is considered relatively safe with few side effects. Generic versions are made in India, and the drug has become the backbone of AIDS treatment in poor countries. Commonside effects include headache, stomach pain and weight loss. Rare but serious side effects include liver and kidney damage.

While the CDC is endorsing PrEP only in conjunction with condoms, health officials say they expect that some people will stop using condoms. Many gay men, including Jacobs, admit to doing just that.

“Making the perfect the enemy of the good is something we’ve got to get over,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases and the country’s best-known AIDS doctor. “I strongly support the CDC doing this.”