Daily Pill Lowers H.I.V. Infection Risk

[rawTOP]

You're wrong that barebacking with a poz top on meds is safer than having sex with a condom who isn't on meds.

No. I'm right...

Condoms are only 90 to 95% effective - see the study that's attached to this post...

http://www.breedingzone.com/threads/...isk-quantified...

Of course that 5 to 10% gap gets reduced because people don't, on average, get pozzed on the first fuck - even with a poz top who's not taking meds, but the point is there's still risk and condoms don't bring it down to zero. Bottom line, there is no such thing as safe sex with a poz top who's not on meds.

Yes, the Swiss Statement said being consistently undetectable puts you close to zero risk. The idea that pills are more effective than condoms (and no pills) was studied and discussed at this year's International AIDS Conference...

http://www.breedingzone.com/threads/...eutic-Vaccines

Of course, being on meds and using condoms is the lowest risk....

BTW, contradicting anything HungLatinDom says about science is foolish - he understands the science behind all this stuff far better than most of us.

[kinkyfucker]

Ehhh.
That is not what I was expecting, based on your commentary. The single author of the opinion you sent, Dr. Albrecht, is not part of the original Swiss study, so not sure where did you get the "original authors recanted" bit.
Ironically, he says:
"Although ART is a promising avenue for preventing the spread of HIV, we need data, not opinions, before we encourage serodiscordant couples to skip the condoms."
Despite he himself gives no data at all.

Sure, infections might happen, but the amount of risk reduction is huge and Rawtop is probably right, plus, the original study addressed the fact that people with other STDs might harbor the virus on their genital tract, despite being UD. However, you are right that the study was only about hetero couples.

This is a science and health debate, so pointing fingers, making up motives and being uncivil won't help anyone.

I cited that source because that was the one we've used on the HIV support website I belong to. I realize it was authored by only a single man, and that he wasn't one of the original authors of the Swiss Statement. He was however, not referring to his own research, but referencing a study conducted by others, many of whom were authors of the original statement. I believe this is the study he is referring to:
http://www.ncbi.nlm.nih.gov/pubmed/21034200

Another study which you might find interesting related to being undetectable and having unprotected sex is this one:
http://www.ncbi.nlm.nih.gov/pubmed/18657710

This article refers to semen being infectious despite an undetectable viral load in the blood:
http://www.ncbi.nlm.nih.gov/pubmed/20929678

This study refers to women with UD blood levels and the persistence of HIV in their genital tracts:
http://www.ncbi.nlm.nih.gov/pubmed/20736815

Another study stating UD in blood does not equate to no virus in semen:
http://www.ncbi.nlm.nih.gov/pubmed/20485526

I could go on and on, but I don't feel like it. These are only some selected studies from the past few months of 2010. I have no other agenda other than to disseminate accurate scientific knowledge to everyone. I'm certainly not making up motives. Perhaps I misunderstood what I read in the follow-up to the Swiss Statement, but I think having read all of these other bits of research, it is pretty clear that most science does NOT support the outcome the Swiss Statement came to.

Best wishes everyone!
kinkyfucker

[rawTOP]

KinkyFucker - The problem is that those studies only say that 1) people are more comfortable barebacking with people who are undetectable, 2) that undetectable in blood doesn't mean undetectable in other areas and 2) that mathematical models say that HIV transmission should be possible with people who are undetectable.

To which I say "so what"? The biggest fallacy is your conclusions are based on the notion that no risk is acceptable. People just don't live their lives that way. We take risks all the time. Crossing the street is a risk. I could trip and fall and get run over by a bus, but I still cross the street. The Swiss Statement was within that context. They acknowledged that HIV transmission risk wasn't zero but basically said it was low enough that it shouldn't be a concern.

The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.” (source)

It's an issue of priorities. Smoking is killing 5 times more gay men yet there isn't nearly the stigma around that, why? Poz guys on meds need to understand that they're not the source of the rise in HIV infection rates (they're shooting blanks). The stigma of sero-discordant sex with undetectable guys needs to be lifted. The problem today is that people are finding out too late that they're poz - after damage as been done. But people aren't getting tested because of the stigma and fear. When you focus on studies like the ones you cite you perpetuate that stigma and fear and make the real problem worse. If you want to bring down the HIV infection rate get people tested - it's guys who think they're neg who are causing most of the infections. If you want to reduce AIDS related deaths get people tested before HIV does damage to their bodies. And deal with issues like substance abuse that are central to risk taking and guys not taking their meds...

[kinkyfucker]

KinkyFucker - The problem is that those studies only say that 1) people are more comfortable barebacking with people who are undetectable, 2) that undetectable in blood doesn't mean undetectable in other areas and 2) that mathematical models say that HIV transmission should be possible with people who are undetectable.

To which I say "so what"? The biggest fallacy is your conclusions are based on the notion that no risk is acceptable. People just don't live their lives that way. We take risks all the time. Crossing the street is a risk. I could trip and fall and get run over by a bus, but I still cross the street. The Swiss Statement was within that context. They acknowledged that HIV transmission risk wasn't zero but basically said it was low enough that it shouldn't be a concern.



It's an issue of priorities. Smoking is killing 5 times more gay men yet there isn't nearly the stigma around that, why? Poz guys on meds need to understand that they're not the source of the rise in HIV infection rates (they're shooting blanks). The stigma of sero-discordant sex with undetectable guys needs to be lifted. The problem today is that people are finding out too late that they're poz - after damage as been done. But people aren't getting tested because of the stigma and fear. When you focus on studies like the ones you cite you perpetuate that stigma and fear and make the real problem worse. If you want to bring down the HIV infection rate get people tested - it's guys who think they're neg who are causing most of the infections. If you want to reduce AIDS related deaths get people tested before HIV does damage to their bodies. And deal with issues like substance abuse that are central to risk taking and guys not taking their meds...

I guess we'll just have to agree to disagree. You feel that encouraging people to do something that is proven to be unsafe is a good idea, whereas I am standing by the science which shows it is not. Fine. I respect your right to disagree.

[rawTOP]

I guess we'll just have to agree to disagree. You feel that encouraging people to do something that is proven to be unsafe is a good idea, whereas I am standing by the science which shows it is not. Fine. I respect your right to disagree.

Not exactly. I'm saying that a life with zero risk isn't one many of us would ever want to live. Stop telling us to live it.

[kinkyfucker]

Not exactly. I'm saying that a life with zero risk isn't one many of us would ever want to live. Stop telling us to live it.

I'm not telling anyone what to do or not do. I'm just wanting to be sure everyone has the correct scientific information on which to base their choices. It'd be like handing someone a gun and telling them it wasn't loaded. Not a very responsible choice. I'd rather make sure people knew the risks so they could make informed decisions about their sexual behaviors. If people want to risk HIV transmission anyway, then that is their prerogative.

[rawTOP]

This thread is (supposed to be) about PrEP...

To me the biggest argument against PrEP is that they want you to take pills for the rest of your life so you can avoid taking pills for the rest of your life. The logic of it just doesn't make sense.

[kinkyfucker]

This thread is (supposed to be) about PrEP...

To me the biggest argument against PrEP is that they want you to take pills for the rest of your life so you can avoid taking pills for the rest of your life. The logic of it just doesn't make sense.

Excellent point rawTOP! Not to mention, if there isn't funding for meds for people already infected with the virus, why do people think there will be funding for PrEP?

[Tucsonmale]

I dont understand guys go out get infected, want aids, Now they want to take a pill. Just dont fuck raw and get knocked up. That would be your best results.

[Bronson]

Well we seem to have a debate on this topic akin to the chicken v egg argument. Let me weigh in with a view:

- I am concerned about one point raised on the strain developing resistance to medications . I see that as the worst possible outcome for everyone.

- risk is walking across the street. from where I live in Asia , there is a better chance of getting hit by a car ignoring signs and rules than getting sick. I have been hit by a car 3 times....not seriously hurt yet.

- if you want no risk then one should live in a bubble. As I see it, Nurses stick me with so many needles and injections for other situation that it is only a matter of time till I get the bug anyway.

We need to appreciate that as the HIV makes it's way into the usa and uk mainstream population, we will see a proper focus and prioritization for an HIV cure. Remember it is still viewed as a disease for us sinners who the mainstream wants to ignore or dismiss. I have read that in the USA that 50+ single white women are the fastest growing group of new HIV+ acquirers. That will start to get noticed soon and everyone will focus on fixing this disease just as there has Been advances with Breast cancer treatments over the past 10 years.

Anyway, I am sure my comments will stir some debate and I welcome dissenting views cause I learn from you guys everyday and very much appreciate your views.

Thanks.

[Bronson]

Sorry RawTop. I should have kept my comments toPreP pill. Feel free to delete my prior post or move it as you deem appropriate. I will be more mindful in future.

[wammt]

Two Studies Show Pills Can Prevent H.I.V. Infection

http://www.nytimes.com/2011/07/14/he...emc=rss&src=ig


Two new studies released on Wednesday add to the growing body of evidence that taking a daily pill containing one or two AIDS drugs can keep an uninfected person from catching the fatal human immunodeficiency virus.



Related

Health Guide: AIDS



The studies were the first to show protection in heterosexuals; the only earlier one with similarly encouraging results involved gay men.

As it becomes ever clearer that modern antiretroviral drugs can not only treat the disease but prevent it, pressure is likely to increase on donors to find more money to supply them in places like Africa and on pharmaceutical manufacturers to either sell them cheaply or release their patents to companies that can.

“This is an extremely exciting day for H.I.V. prevention,” said Dr. Kevin Fenton, director of AIDS prevention at the Centers for Disease Control and Prevention in Atlanta. “It’s clear we’re not going to find a magic pill that prevents it, but this is adding more to the tool kit.”

Until a few years ago, condoms and abstinence were alone in that tool kit. Recent studies have added circumcision, vaginal microbicides, a daily pill for the uninfected (known as pre-exposure prophylaxis, or PrEP) and early treatment for the infected (known as “treatment as prevention”).

One study released Wednesday, known as Partners PrEP and conducted in Kenya and Uganda by researchers from the University of Washington, showed that participants who took a daily Truvada pill — a mix of tenofovir and emtricitabine — had a 73 percent lower chance of getting infected. The study was done in 4,758 “discordant couples,” those in which one partner was infected and the other was not. Partners who took a Viread pill — which contains only tenofovir — had a 62 percent lower chance.

The second study, called TDF2 and done in Botswana by the C.D.C., found that those taking Truvada had a 63 percent lower chance of infection. The subjects were 1,200 sexually active young adults.

The studies were due to be released at an AIDS conference in Rome next week. But the University of Washington study was stopped early because it was so clear that the pills were working that it would be unethical to continue distributing placebos. The C.D.C. decided to release its results simultaneously.

These studies follow a breakthrough pre-exposure prophylaxis study, known as iPrEx, that was conducted among gay men in San Francisco, with the results published in November. In it, men who took Truvada daily were 44 percent less likely to become infected. But those whose blood samples showed they took it faithfully had 90 percent protection.

Then in April, the field had an unexpected setback, when FEM PrEP, a study in African women, was stopped early because it was not working. Researchers questioned whether many women either did not take their pills or gave them to their infected boyfriends or husbands.

Blood samples are the best way to tell whether study participants actually take their pills. Blood samples were drawn in both that study and the two new studies, but because all three stopped early, the samples have not been analyzed.

Two similar studies are in the works — another among heterosexuals in Africa and one among drug users in Thailand.

“We don’t anticipate needing more,” said Dr. Jonathan Mermin, a C.D.C. specialist in AIDS prevention.

The new studies may lead some heterosexual Americans to ask their doctors for Truvada. Although it will take several months to write new C.D.C. guidelines, Dr. Mermin said, doctors could use the guidelines written for gay patients after the San Francisco study, with the proviso that Truvada has not been tested in pregnant women.








A version of this article appeared in print on July 14, 2011, on page A17 of the New York edition with the headline: Two Studies Show Pills Can Prevent H.I.V. Infection.