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CDC recommends HIV-prevention drug to people at high risk of infections

New guidelines build on a 2010 study that found Truvada was more than 90 percent effective at preventing HIV

U.S. health officials Wednesday issued new recommendations urging health care workers to consider offering an HIV prevention pill to healthy individuals who are at substantial risk of infection by the virus.

The guidelines, issued by the U.S. Centers for Disease Control and Prevention and the U.S. Public Health Service, involve the use of pre-exposure prophylaxis, or PrEP – a strategy in which at-risk individuals take a daily dose of an antiretroviral drug to reduce their risk of HIV infection.

The strategy builds on a landmark 2010 study that found Truvada — a pill already widely used to treat HIV — was more than 90 percent effective at preventing HIV infections among test subjects who took the drug as prescribed.

According to the new guidelines, health care providers should consider PrEP for anyone who meets specific risk criteria, such as being in a relationship with an HIV-infected partner or having sex without condoms with partners known to be at risk for HIV, such as injecting drug users.

The guidelines offer the first comprehensive guidance from the CDC, replacing interim guidance that emerged after studies showed PrEP to be effective in different patient populations.

The CDC now estimates that as many as 275,000 uninfected gay men and 140,000 heterosexual couples, in which one partner is HIV-infected, could benefit from PrEP.

Some 1.2 million people in the United States live with HIV, and new infections are estimated at 50,000 each year.

According to The New York Times, the announcement from the CDC is likely to mean a massive increase in the number of prescriptions written for the drug each year, up to 500,000 from its previous level of 10,000 a year.

The HIV infection rate in the U.S. has remained roughly the same at 50,000 new infections each year, despite 30 years of widespread outreach campaigns promoting the use of condoms to block transmission of the disease, leaving researchers frustrated at the lack of progress.

There is hope that it will make a significant impact in the gay community, particularly because of a sudden increase in unprotected sex.

Results from a CDC survey released in November showed the number of gay men that reported having unprotected sex increased almost 20 percent from 2005 to 2011.

Potential problems

But not everyone feels PrEP is the right answer. AIDS Healthcare Foundation President Michael Weinstein told Al Jazeera that he has been vehemently against Truvada — also referred to as PrEP — saying test studies have offered insufficient proof that the drug really prevents HIV transmission as it claims. Weinstein said he sees the government sanctioning of the drug as using young gay men as “guinea pigs.

“This will lead to more infections,” Weinstein told Al Jazeera. “You don't have to give gay men more excuses not to use condoms.”

Kathy Brown, HIV Program medical director at the Seattle-based health care nonprofit organization Group Health, told Al Jazeera she disagrees with critics who think Truvada will promote risky behaviors.

When Brown prescribes Truvada to her patients, she says, “they feel like they have more control over their risk and in some cases may take less risks, because they no longer have this fatalistic thought that ‘it doesn't matter what I do, I'm going to get infected sooner or later.’”

But Brown cautioned that the regular use of Truvada presents other risks. Among a slew of potential side effects, Brown says, some patients have experienced nausea and “severe kidney problems” that appear to have reversed since they stopped using the drug. Others have reportedly complained of resulting health complications affecting blood, liver and bone density.

The notification on Truvada suggests that patients discuss taking it with their physicians, but for many, that is not proving very helpful. 

In a report from  the health care advocacy group Health HIV, nearly half of all personal care providers said that they do not provide clinical HIV care, and that a lack of knowledge about HIV treatment and prevention is “a significant barrier” to providing care.

Some state health departments have been making an effort to teach doctors how to properly prescribe Truvada and to provide better counseling on HIV issues. Many state health official are devising plans to more effectively do so as well.

Al Jazeera and wire services. Massoud Hayoun contributed to this report.

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