Good news comes in threes

The Associated Press is calling it the most hopeful day in the history of the AIDS epidemic. Yesterday there was news of a new daily pill that dramatically reduces new infections; the pope approved condoms as the the lesser of two evils for preventing HIV infections; and the United Nations declared that the number of new HIV cases worldwide had dropped by a fifth over the past decade.

The new pill, a combination of tenofovir and emtricitabine and sold in drugstores as Truvada, reduced HIV infections by 44 percent among men who have sex with men (MSM) compared to a treatment using placebos. Men who were diligent about taking the drug daily reduced their risk by as much as 90 percent, according to the study of 2,499 men and transgendered women in six countries. After a little more than a year, 36 people who were getting Truvada became infected with HIV, compared to 64 participants in the control group. Blood tests found nearly all of the men in the Truvada group who were infected had not been taking the drug as prescribed.

“That’s good, but it seems gay men and others are still engaged in risky behavior,” says ACSH’s Dr. Elizabeth Whelan.

“As incredible as this development is — and I’ve never seen anything like this before — it’s definitely going to promote risky behavior,” says ACSH’s Dr. Josh Bloom, a former AIDS researcher for Wyeth.

“It’s still a good thing,” says Dr. Whelan. “We don’t want to be judgemental about people’s behavior, but it’s really a problem. We provide medicines, vaccines, that sometimes enable people to continue their risky behavior. But overall, it’s a very good thing.”

“It’s an amazing discovery,” agrees Dr. Bloom. “This is somewhat analogous to a vaccine for AIDS, which has been sought after for 25 years to no avail. A decade ago, the concept of highly effective prophylactic AIDS medications would have been considered science fiction. What is being required of these antiretrovirals is extraordinary. The drugs have to function after infection in a manner so effective as to wipe out all the virus before it takes hold. “

ACSH’s Dr. Gilbert Ross concurs. “The real impact will occur in those areas where AIDS is rampant — Africa, Asia and Russia/Ukraine — when access for susceptible populations is enhanced, especially via price reductions.” (Made by Gilead Sciences, Truvada can cost as much as $12,000 to $14,000 a year in the U.S., although in poor countries generic versions can be had for pennies a pill).

Meanwhile, the UN declared that last year 2.6 million people worldwide contracted HIV, down 19 percent from the 3.1 million recorded in 2001. Antiviral drugs that prevent mother-to-child transmission are being given some of the credit.

“They (the UN) basically say the epidemic has been halted,” says Dr. Bloom. “If you had said this 10, 15 years ago, they would have looked at you as if you were crazy. It is now possible to halt mother to fetus transmission, a major factor in the spread of AIDS across Africa, by use of antiretroviral drugs.”

Finally, the pope has clarified his comments from over the weekend on the use of condoms, saying they applied to everyone, male and female. There had been some confusion because in his previous interview in his native German, Pope Benedict XVI had used the masculine form of the word “prostitute,” which was then translated into English as “male prostitute.”

Vatican spokesman the Rev. Federico Lombardi said he asked the pope if his phrasing was deliberate and Benedict said no. "This is if you're a man, a woman, or a transsexual. We're at the same point. The point is it's a first step of taking responsibility, of avoiding passing a grave risk onto another," Lombardi said.