Who Should Get PrEP? Preventing HIV with a Pill

The current recommendations for PrEP (pre-exposure prophylaxis) or prevention of HIV infection in people who are HIV negative are as follows:

1.  It should be targeted to people at very high risk for HIV infection.
2. PrEP should be taken daily for it to be effective.
3. Women who are pregnant or trying to conceive should discuss the risks vs. benefits of PrEP with their doctor.
4. PrEP should be part of a comprehensive pack of prevention services that include regular HIV testing, risk reduction, adherence counseling, and testing and treatment of sexually transmitted infections .
5. PrEP should only be prescribed for people who are HIV negative.  Why is this?  Because PrEP uses only one or two HIV medications to prevent infection, and HIV treatment requires three medications.  We would never treat someone with HIV with only one or two HIV medications.

Do you know of a program to help people get Truvada for PrEP?  In Minneapolis, there is a program at Red Door Services for men enrolled in the HIM program, but it is a small pilot program.  Does your community have a similar program to access PrEP?

Tomorrow we’ll look at some exciting studies looking at better ways to give PrEP in the real world.

Best,

Bill

 

 

Capri Theatre to Host World AIDS Day Event with LaMont Wheat and Jamar Rogers November 30th

The Capri Theatre in Minneapolis will be the site of two coördinated programs designed to educate and entertain on Friday, November 30th.  The first event, The Brother Circle Dinner takes place 4-6 pm, and includes free food and discussion with Jamar Rogers, semifinalist on “The Voice” and LaMont Wheat, songwriter and performer of “Still Standing.”

The Sarah Simmons Showcase will take place from 6-8 pm at the Capri.  This event is a community talent show.  It will also features songs by special guests, Jamar and LaMont.  If you would also like to perform in the Showcase, please register by November 15th with Peggy Darrett-Brewer at 651-201-4138 or email peggy.darrett-brewer@state.mn.us.

Both events will include free information on HIV prevention, free condoms, free STD testing, and free door prizes.

It is going to be a fantastic evening, and the culmination of ten months of work by me with The Black AIDS Institute, African American HIV University and our own Black HIV Coalition.  It has been an honor to work with  inspiring people in Minneapolis and around the country to reduce HIV in Blacks.  Blacks are the most impacted group by HIV of any race or ethnic group in the United States.  Black gay and bisexual men are particularly hard hit by HIV.

 Built in 1927, the Capri Theater’s storied history includes 35 years as the Paradise Theater (from 1933 to 1967), as well as the place where Prince launched his international music career in January 1979. Located at 2027 West Broadway (one block east of Penn Ave. North), the Capri Theater is owned and operated by Plymouth Christian Youth Center (PCYC).  (Capri Website)

So join us for this fun evening of food, music, entertainment, and education.  Be part of the cure.  Let us end HIV in our lifetimes.

Yours,

Bill

How to Survive and Thrive with HIV

Image via Wikipedia

 

Living with HIV is a challenge, but medications for HIV are truly life-saving.   I should know, because these medications saved MY life.  As a pharmacist for thirty years, I have been around the block a couple of times.   For the last ten years, I have helped hundreds of people to be successful with HIV medications at  clinics in Minneapolis and St. Louis Park in Minnesota.  I provide individual consultations for HIV medication adherence through a Federal grant program.What is medication adherence?  It is helping people take their medications correctly every day so they have great results.I am often asked by people unfamiliar with HIV or people just starting treatment,  “What’s so hard about taking a pill every day?”Taking medication daily DOES have its challenges.  I’ll be exploring these challenges, and ways to overcome them in this blog.  I’m also developing a website at williamlarsonpharmd.com and a FaceBook Page, and videos are soon to come!

I look forward to hearing from you and getting your comments and feedback.

Wishing you a great day!

Bill

PrEP: Preventing HIV with Truvada

This week I’m reviewing work underway at the Health Prevention Trials Network (HPTN) on PrEP, or pre-exposure prophylaxis of HIV.  This is giving HIV medication to people who are negative who are at high risk of  becoming infected.

If you are wondering why it’s not just for whores, watch this video:

So Truvada is for anybody who might have an occasional slip up or regular slip ups in terms of using a condom during sex.  One of the concerns about PrEP is that it could be challenging to take daily, as currently recommended.  Would it work if you took it less frequently?  That is a question waiting for an answer.

The HPTN 067  or ADAPT Study is going to help answer that question.  ADAPT stands for “Alternative Dosing to Augment PrEP pill-Taking”.  Clever name, don’t you think?

This study will examine what is the most effective way to take PrEP.  One third of the participants will take Truvada daily, 1/3 will take it just before and after sex, and the final 1/3 will take it two times a week and a booster after sex.

Participants should take no more than 2 tablets in a 24-hour period or seven  tablets in a week.

This study will enroll men who have sex with men (MSM) and women.

If intermittent PrEP works as well or better than daily PrEP, this would make PrEP more acceptable, easier to use, possibly safer, and less expensive.

The ADAPT study is taking place in Cape Town, South Africa, Bangkok, Thailand, and New York, US.

What about other medications besides Truvada for PrEP?  Tomorrow we’ll look at a study that is looking at maraviroc for PrEP.

Are you taking PrEP?  Are you enrolled in a trial, getting it through your doctor’s office, or somewhere else?

Best,

Study Will Answer Question: Will Black Gay/Bisexual Men Take a Pill to Prevent HIV

HPTN 073 is examining PrEP in Black men who have sex with men (BMSM).  Why BMSM?  Because BMSM account for 28% of all new HIV infections in the US, while representing less than 1% of the population.

HPTN 073 is a demonstration project of Truvada combined with comprehensive clinical care coordination in 225 participants in 3 US sites, Washington, DC, Chapel Hill, NC, and Los Angeles, CA.

The questions to be answered by HPTN 073 are:

1.  Will Black MSM use PrEP?
2. Is PrEP safe for Black MSM?
3. Does it work to combine client-centered care coordination along with PrEP to BMSM.

Client centered care coordination is defined as follows:   “This is an approach in which each client’s unique biological social and interpersonal realities are taken into consideration with the goal of optimizing retention and adherence.”

That seems like a bunch of gobbledygook to me, but as I read further, I learned that  it is really just bringing various healthcare workers, such as social workers, case managers, pharmacists, and nurses, together to figure out what the client needs to be successful to improve their health and reduce barriers to their care.  Barriers to care would include poverty, homelessness, substance use, mental illness, and incarceration.

Not enough has been done to study PrEP in Black MSM, so this is an exciting study which will help us understand how to best use PrEP for this group.

If you are a Black male who has sex with men, would you enroll in this study?

PrEP Results Showed No Effect in Women in Two Studies in Africa

Yesterday I reviewed evidence that PrEP actually works to prevent HIV infection in people who are negative.  

Today I am reviewing studies that did not show that PrEP works. 

The first is FEM-PrEP, a study of 2120 women in Kenya, South Africa and Tanzania.  These women were not enrolled in the study as part of a couple.  It compared Truvada  (tenofovir/emtricitabine) to placebo, and Truvada was found ineffective in preventing HIV due to low adherence, only about 33%.

The second disappointing study was MTN-003 (VOICE), which looked at 5,029 women in South Africa, Uganda, and Zimbabwe.  It compared tenofovir (Viread ) vs. placebo, Truvada to placebo, and tenofovir vaginal gel vs. placebo.  No product proved effective in preventing HIV due to low adherence, estimated at only 23-29%.

Why did these studies show that the active drug was ineffective in preventing HIV infection, when the studies I discussed yesterday found that PrEP works?  The main reason was lower adherence.  In the FEM-PrEP and Voice studies, the women were not taking enough medication to get any effect from it.

Why didn’t the women adherence better to the PrEP?  Although we do not know, some of the reasons might be cultural, mistrust of the medication, or believing they were not at risk for HIV infection.

Tomorrow we’ll look at the current recommendations for who should receive PrEP.

Evidence for the Effectiveness of PrEP: Pre-Exposure Prophylaxis for Prevention of HIV in Negative Folks

Today I’d like to review the evidence that PrEP actually works to prevent HIV infection in people who are negative.

The first such study is called iPREX, a study of 2499 gay men in sites including Peru, Ecuador, Brazil, Thailand, Boston, San Francisco.  The iPREX study compared Truvada (tenofovir/emtricitabine) to placebo for preventing HIV infection.  The study found that Truvada was 44% effective in reducing HIV infection.  It’s effectiveness increased to 92%, however, if drug levels were detectable.  If drug levels are detectable, this means that the study participant was actually taking the medication.

The second study is CDC-TDF-2, which looked at HIV prevention in 1200 adults in Botswana, 45% of whom were women.  It compared Truvada to placebo, and in the Truvada group, new infections were reduced by 62%.

The third study to find the PrEP works was the Partners PREP study of 4578 serodisordant couples living in Kenya and Uganda.  A serodiscordant couple is one in which one person is negative and one is positive.  It compared tenofovir (Viread), Truvada, and placebo.  Viread reduced HIV infections by 67%,  and Truvada reduced infections by 75%.  Effectiveness for Truvada increased to 86-90% if drug levels were detectable.

Tomorrow we will review PrEP studies which were not so encouraging.

 

Truvada for PrEP: Is it the Right Drug?

I am writing a series of blogs on new methods of prevention of HIV infection in preparation for a Brown Bag Lunch I’m giving at Turning Point in Minneapolis tomorrow on this topic.

Truvada is the main anti-retroviral agent (ARV) used for PrEP (pre-exposure prophylaxis, or administration of HIV medications to persons who are negative to prevent infection).

Why was Truvada chosen for PrEP?

Because it has limited side effects, its is generally very safe, it lasts a long time in the body, and it does not tend to lead to drug resistance compared to other ARVs.

Dr. Mayer believes we are in the “early days” of using PrEP, and that this area will evolve over time as we learn how to best give it.  In addition, other medications are now being tested for PrEP which might be safer or be more effective.

Preventing HIV Infection With HIV Medication: Because It Works!

I’m writing a series of blogs on PrEP or pre-exposure prophylaxis for prevention of HIV infection in people who are negative.  Yesterday I wrote about Truvada and its use for PreP.

So why is there so much interest in PrEP?  Because we know it works.  Data from animal and human studies proved that PrEP is effective in preventing HIV.  I’ll write about some of those studies tomorrow

We have used PrEP for years in other settings.  We know that giving ARVs (antiretroviral medication) to pregnant women prevents their baby from getting HIV.

We also know that Post-Exposure Prophylaxis (PEP) works for preventing HIV in accidental needle sticks.   This mostly occurs in health care workers when they accidentally get a needle stick from a patient with HIV.  We give them daily ARV medication for a month post-exposure to prevent HIV transmission. Most of the studies using PrEP involved taking daily oral medications, something which is difficult to accomplish under the best of circumstances.  Would intermittent PrEP work?  Intermittent PrEP is taking ARV medication at certain times, such as before and after sex.  Intermittent PrEP would reduce the cost of medication and reduce the amount of medication given to a HIV negative person, perhaps increasing safety.

Do you think PrEP will work for in the real world?  This is the question researchers are trying to answer.

Would you take a daily medication to prevent HIV infection?

Tomorrow we’ll examine reasons why Truvada is used for PrEP.

 

Truvada Prevents HIV in People Who Are Negative. Will They Take It?

This week I am writing about new methods of preventing HIV using medications, also known as biomedical interventions.  Much of the material comes from Kenneth Mayer, MD, Medical Research Director and Co-Chair of the Fenway Institute and part of the executive committee for the HIV Prevention Trials Networks (HPTN).

Dr. Mayer presented information on PrEP (Pre-exposure prophylaxis) at a webinar recently for the Train-the –Trainer series by the Black AIDS Institute.  I’ll be sharing this information at a Brown Bag Lunch at Turning Point, 1500 Golden Valley Road, Minneapolis, MN on Friday, April 19^th at noon.  If you are interested in attending, let me know.

PrEP is a new approach to preventing of HIV infection in people who are negative using HIV medications, also known as antiretroviral medications or ARVs.  Last year, the FDA approved tenofovir/emtricitabine (Truvada) for exactly this use.  This was a big deal, because this was the first time a medication was approved to give an ARV to a negative individual to prevent infection.

Truvada is not a new medication, however.  This combination pill forms the backbone for must ARV treatment regimens for people with HIV.

PrEP is actually quite complicated, and involves more than just telling someone to take a pill daily to prevent HIV.  It’s part of a HIV prevention package that includes ways to lower your risk, such as fewer partners, and condom use.

Have you heard about PrEP or the use of Truvada for this purpose?  Are you using it, or anyone you know using it?  What is their experience with it?

Tomorrow I’ll write more about PrEP and whether it works.

First Brown Bag Lunch to Highlight Biomedical Prevention of HIV: Going Beyond Condoms

Yesterday, I told about a fellowship I recently completed with the Black AIDS Institute  (BAI).  It just ended in February, but my work with the BAI is certainly not over.  They started a new one year program called Train-the-Trainer and Brown Bag Lunch series designed to teach participants to lead 4-7 programs on various topics in their own community.  I jumped at the chance, not because I need to add more things on to my schedule, but because it gave me the opportunity to learn from national leaders and then present the information locally to groups that most need to hear it.

Today’s topic was “Integration of Biomedical Interventions and Behavioral Interventions in Reducing HIV Infection.”  The presenter was Kenneth Mayer, MD, Medical Research Director, Co-Chair of the Fenway Institute.  Dr. Mayer is a Professor of Medicine at Harvard Medical School and serves as chair of the HIV Prevention Trials Network (HPTN).  He is also chair of the MSM Working Group for the Executive Committee of HIV Prevention Trials Network.  He was t he perfect presenter on this topic, because he was involved in much of the research he presented.

So what is a behavioral intervention in the prevention of HIV?  The one that first comes to mind is wearing a condom before having sex.  You have to do something (a behavior) to make this work, however.  Many studies show that a considerable percentage of gay men, about half, do not use condoms consistently.  The same is true for Black gay men or MSM.

A biomedical intervention would be a medication that prevents HIV infection.  Interestingly, even biomedical interventions require a behavior:  actually taking the medicine correctly.  We call this adherence, and it is the focus of my job.

The biomedical interventions that Dr. Mayer presented were pre-exposure prophylaxis, or PrEP and treatment as prevention (TasP).   Pre-exposure prophylaxis is taking a medication BEFORE you become infected in order to prevent infection.   PrEP would be used in someone who is HIV negative but at risk for becoming HIV positive.  TasP refers to treating someone who has HIV with medications to protect their health from HIV and to prevent the spread of HIV to their sexual partner.

I’ll be reviewing some of the studies presented by Dr. Mayer in upcoming blogs.  Here’s a tickler:  Truvada for PrEP is just the beginning.

What a Year it has Been! Completing my Fellowship with the Black AIDS Institute

It’s been a while since I’ve blogged, so my apologies if you’ve been looking for regular updates from me.  I finished up a huge commitment in February.  I graduated from the African American HIV University Community Mobilization College (AAHU CMC) at the Black AIDS Institute.  This was an eleven month program that taught me skills on assessing HIV in my community, conducting a needs assessment, and forming a coalition of Black leaders to address the disproportionate rate of HIV in Blacks in Minneapolis.  We then planned and conducted a mobilization event to increase awareness of HIV, provide HIV testing, and educate about HIV in the Black community.  The event was a blast, and that will be a topic of a future post.

Blacks are  the race or ethnic group most impacted by HIV in the United States is Blacks.  Black make up 12% of the population, yet account for nearly half of new infections.

We seem the same disturbing trend in Minneapolis, where I live.  Blacks make up only 19% of the population, yet account for 40% of new HIV infections. 

I chose to target Black men who have sex with men BMSM) , including gay and bisexual men for my mobilziation.  This group accounts for most of the new infections in Blacks in Minneapolis.   Although they represent less than 1% of the US population, BMSM account for 28% of all new HIV infections.  Most alarming, this rate of infection for BMSM in the US is comparable to the rate found in sub-Saharan African countries.

HIV is a preventable problem.  Yet we have new infections occurring every day in the US, and communities of color are most vulnerable.  Clearly, we can do better. 

In the coming days and weeks, I’ll be writing more about my experiences with the Black AIDS Institute and the AAHU CMC.  It was an incredible experience, and I want to share the information I learned with you.

Yours,

Bill