HIV/AIDS Research Feed

March 03, 2011

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Effective HIV Prevention Programs in the U.S.

By Miguel Gomez, AIDS.gov Director

On Monday, February 28, Dr. Jonathan Mermin gave a plenary presentation at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) Exit Disclaimer in Boston. Dr. Mermin is the Director of the Division of HIV/AIDS Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  His talk was titled The Science and Practice of HIV Prevention in the U.S Exit Disclaimer. We encourage you to view and/or listen to his presentation, which includes slides and data.

Dr. Ronald Valdiserri had the opportunity to talk with Dr. Mermin after his presentation, and we wanted to share their conversation with you. Please enjoy the following podcast and give us your feedback.

To watch other presentations from CROI, visit the conference Webcast Sessions page Exit Disclaimer.

February 27, 2011

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Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

CAPTION

Dr. Ronald Valdiserri

On Saturday, February 26th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.

The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.

Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.

When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.

The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

  • Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
  • Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
  • In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
  • How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
  • Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?

While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.

Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

November 23, 2010

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NIH-Funded Study Finds Daily Dose of Antiretroviral Drug Reduces Risk of HIV

By Jeffrey S. Crowley, Director, Office of National AIDS Policy (Cross-posted from the Office of National AIDS Policy Blog)

Today, the New England Journal of Medicine published research findings from the iPrEx study funded by the National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation testing the efficacy of pre-exposure prophylaxis (PrEP). The study is a major step forward in our ability to prevent new HIV infections. The study found that a daily dose of an oral antiretroviral drug taken by HIV-negative gay and bisexual men and transgender women reduced the risk of acquiring HIV infection by 43.8 percent. The data showed even higher levels of protection from infection, up to 73 percent, among those participants who adhered most closely to the daily drug regimen.

Continue reading "NIH-Funded Study Finds Daily Dose of Antiretroviral Drug Reduces Risk of HIV" »

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President Obama Welcomes New HIV Prevention Research Results

Cross-posted from The White House, Office of the Press Secretary

WASHINGTON, D.C. – Today, the National Institutes of Health announced findings on recent HIV prevention research.  The study finds that a daily dose of an oral antiretroviral drug taken by HIV-negative gay and bisexual men reduced the risk of acquiring HIV infection by 43.8 percent, and had even higher rates of effectiveness, up to 73 percent, among those participants who adhered most closely to the daily drug regimen.

“I am encouraged by this announcement of groundbreaking research on HIV prevention. While more work is needed, these kinds of studies could mark the beginning of a new era in HIV prevention. As this research continues, the importance of using proven HIV prevention methods cannot be overstated,” said President Obama.

One of the President’s top HIV/AIDS policy priorities was the development and implementation of a National HIV/AIDS Strategy (NHAS), which was released in July 2010. As underlined in the NHAS, no HIV prevention method is 100 percent effective, and a combination of approaches including, among other steps, consistent condom use, will be necessary to prevent HIV infection.  Nevertheless, the research results announced this past summer of an effective microbicide and today’s results fall directly in line with priority recommendations in the NHAS.  Moreover, today’s study suggests that antiretroviral medication may serve as one more valuable tool as we seek to develop the best combinations of effective approaches to prevent HIV infecti

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New Announcement about PrEP from NIH

By Carl W. Dieffenbach, Ph.D., Director of NIAID’s Division of AIDS

NIAID

The National Institutes of Health National Institute of Allergy and Infectious Diseases just made a significant announcement on pre-exposure prophylaxis (PrEP). I am proud to share this important update from the NIH with our blog readers. Learn more by reading this Q&A.

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