Daily Preventative Drug Treatment Considered For Gay Men At High Risk of Contracting HIV
A cost-benefit analysis issued earlier this week claims that tens of thousands of new HIV infections could be prevented if gay men who have five or more sex partners per year took a daily preventative treatment drug. The New York Daily News reports:
The study by experts at Stanford University, published in the Annals of Internal Medicine, looked at the costs involved with prescribing a $26 a day pill to men who have sex with men. The pill, Truvada (tenofovir-emtricitabine), was shown in a landmark 2010 trial published in the New England Journal of Medicine to prevent HIV infections in as many as 73 percent of gay men who took it regularly. Gay men account for the more than half of the 56,000 new cases yearly of human immunodeficiency virus in the United States, according to the Centers for Disease Control and Prevention. However, questions have been raised about whether it would make financial sense to recommend that large populations of gay men take a daily pill as prevention, or a technique known as pre-exposure prophylaxis (PrEP). "Promoting PrEP to all men who have sex with men could be prohibitively expensive," said Jessie Juusola, a PhD candidate in management science and engineering in the Stanford School of Engineering and first author of the study. "Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank." Prescribing the pill generally to men who have sex with men in the United States would cost $495 billion over 20 years, but targeting those at highest risk only would bring costs down to $85 billion, said the study. Looking out over the next two decades, researchers calculated a total of 490,000 new infections if PrEP is not used. But if 20 percent of gay men take the pill daily, there would be nearly 63,000 fewer infections. And if just 20 percent of high-risk men took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.
This sparks some interesting questions and concerns. First off, Truvada's "common" side effects, as listed on drugs.com, sound pretty horrific:
Abnormal skin sensations; back pain; cough; darkened skin color on the palms of hands or soles of feet; diarrhea; dizziness; gas; headache; indigestion; joint pain; loss of appetite; nausea; sinus drainage; skin discoloration (small spots or freckles); strange dreams; sweating; tiredness; trouble sleeping; vomiting; weakness; weight loss.
Secondly, the study doesn't address the population that public health researchers term "Men who have sex with men â€” non-gay identified." These men often pass under the radar of anti-HIV initiatives, especially one that would require the sort of long-term monitoring and patient compliance that daily doses of PrEP would require. Finally, forcing or even strongly requesting that gay men who have more than five sexual partners a year take a daily medication with significant side effects and an incredibly high financial cost will almost certainly encounter huge opposition and dissent, be it from gay men who don't want to medically stigmatize themselves, to conservative economists who wouldn't look at a $16- to $85-billion public health experiment as a necessary or desirable expenditure. On the other hand, widespread PrEP for high-risk men could potentially prevent new infections and help to contain the spread of HIV in a social group severely impacted by the disease. According to CDC statistics men who have sex with men accounted for 61% of all new HIV infections in the U.S. in 2009, as well as nearly half (49%) of people living with HIV in 2008 (the most recent year national prevalence data is available). While the CDC estimates that only 2% of the U.S. male population aged 13 and older has sex with other men, they accounted for more than 50% of all new HIV infections annually from 2006 to 2009, and 61% of new HIV diagnoses in 2010. Even more frighteningly, 20% of those infected with HIV don't know that they have it, and are receiving no treatments that could lower their viral load. With all these things in mind, PrEP could make sense to prevent men at the highest risk of seroconverting from becoming vectors for other men to seroconvert, resulting in fewer overall new HIV infections amongst gay men. What do you think, readers? Would preemptive Truvada treatment be a good idea for gay men? Would you agree to such a treatment, knowing the potential risks, side effects, and benefits for yourself and the community? Share your thoughts in the comments!