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Scientists Consider Pills To Avert HIV

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The New York Times

Published: August 4, 2008

MEXICO CITY - Can a pill a day help prevent infection from HIV, the virus that causes AIDS?

No one knows. But researchers in a number of countries are conducting trials and planning others to test the unproven strategy that a daily pill, or a combination of drugs, can prevent HIV.

By mid-2009, more people will be enrolled in such trials than in all of those for HIV vaccines and microbicides, the AIDS Vaccine Advocacy Coalition said in a report issued here on Sunday at the start of the 17th International AIDS Conference.

Initial findings of the safety and effectiveness might come early next year, although researchers do not know how they will compare with the disappointing results of recent tests of HIV vaccines and microbicides.

In the face of those bleak findings, some AIDS experts say testing the prophylactic use of antiretroviral drugs - called PrEP for pre-exposure prophylaxis - is now the most promising research in HIV prevention efforts as scientific investigation of vaccines and microbicides continues.

The national Centers for Disease Control and Prevention said that PrEP was among the strategies that needed to be developed to substantially reduce the incidence of HIV. An estimated 2.7 million people worldwide become infected each year.

"We cannot wait for the study results to begin to prepare for the optimal use and delivery of PrEP," said Pedro Goicochea, an investigator in a PrEP study under way in Peru and Ecuador. "Instead, we should look ahead to consider all of the possible outcomes of these trials and make real plans for making PrEP available to those who can benefit from it, as quickly and safely as possible if it is proven effective."

The U.S. Agency for International Development, the CDC and the National Institutes of Health are paying in part for all of the trials. The Bill & Melinda Gates Foundation is paying for part of two.

Because PrEP might also work in a significant percentage of uninfected users, the advocacy coalition and other researchers say now is the time for governments, health officials, donors, researchers and advocates for AIDS research to prepare for the maximum public health benefit if the pill-a-day strategy works.

One reason for the immediacy, they say, is that even if a PrEP strategy proved successful, it would not be a silver bullet. PrEP would need to be combined with standard prevention measures like safer sex practices, use of condoms and clean needles, and counseling.

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