HIV, AIDS, and How PrEP Can Help
By Shannon Jones, Marine Biology, 2016
In Issue 12, Hessu Kim reported on a new method for the prevention of HIV/AIDS. Since 2011, the method discussed has come into general practice. For our retrospective issue, all of us at NUSci thought that updating this article would be worthwhile.
Human Immunodeficiency Virus, or HIV, is a virus that gradually affects the T cells in the body. Normally, T cells perform many functions: helping to make antibodies, recruiting white blood cells, defending against microbial, inflammatory and infectious activity, and coordinating the overall immune responses. When HIV is present in a person’s system, the immune system progressively loses the ability to fight diseases and infections. Over time, this leads to a point where so many T cells have been destroyed that the person is diagnosed with Acquired Immunodeficiency Syndrome, or AIDS. Meanwhile, massive research efforts are being poured into prevention, delaying disease progression, and curing the disease altogether.
Though there is no cure for AIDS, a person can stall the progression from HIV to AIDS. After the initial infection, a person experiences mild symptoms, if any, as the virus remains dormant for a period of time, with low amounts of virus present in the blood. Many researchers consider stalling during this “undetectable” period the best way to delay the progression into AIDS.
In 2011, NUSci reported on a study that suggested that antiretroviral drugs, or ARVs, could be used as a way to prevent the transmission of HIV. In 2012, this method of prevention of HIV transmission was approved by the FDA. PrEP, or Pre-Exposure Prophylaxis, is a once-daily ARV pill for people who are at high risk for HIV that can greatly reduce the likelihood of HIV infection when a person is exposed. Similar ARVs are used in PEP, or Post-Exposure Prophylaxis, which can be used immediately after exposure to a HIV-positive individual to reduce the chance of positive HIV infection. Between the two, many individuals can be protected from HIV infection.
When PrEP was first introduced, many people who were using it were older and more frequently female. However, male usage has increased recently, as has usage in the younger population.
Though this is good news for people who are at high risk for HIV infection, several concerns remain. Right now, PrEP is available by prescription, but few people are taking advantage of it. This may be due to a stigma — people who are on PrEP are sometimes seen as more promiscuous or less careful than those who are not taking PrEP. Critics of PrEP are concerned that it could lead to people becoming less circumspect in their partners, or less vigilant in asking about a partner’s HIV status.
Condoms are intended to be used in conjunction with PrEP, but critics are concerned that there will be decreased usage of condoms when an individual is protected from both HIV and pregnancy (naturally, by gender, or artificially, by birth control). In addition, PrEP has to be taken daily, and has not been proven as effective below a 90 percent adherence rate — in other words, researchers worry that people won’t take their pills on time, which reducing the effectiveness dramatically. Researchers are working to expand the forms of PrEP to vaginal gels and injectable forms, but as of right now, the once-daily pill is the only option. Critics are even more concerned about the use of a preventative drug in a non-infected patient — the effects on the patients taking daily PrEP are still being studied. Critics worry that PrEP will have an effect on uninfected individuals, and that PrEP usage might create a drug-resistant form of HIV.
However, perhaps the most prohibitive aspect of PrEP is the cost of the drug. PrEP can cost up to $14,000 a year depending on health insurance coverage. People must also go to the doctor every three months to refill the prescription and to get regularly tested, ensuring that they remain HIV negative. Recently, Kaiser Permanente, the makers of the major PrEP medication Truvada, changed from a co-pay system, where the consumer pays a small fixed amount, to a system where the consumer pays a percentage of the total. This raised the price for the consumer dramatically.
After backlash from users, advocates, and politicians, prices were dropped and costs were refunded to some consumers. However, this move has only served to grow the black market for PrEP medication. Taking PrEP from a non-recognized source means taking it without the support and quarterly monitoring that benefits legal users. This leads to a higher risk — how can people confirm the drugs they receive are effective? How can they confirm their continued health on them?
Overall, PrEP could be a highly effective way to combat HIV. However, many concerns remain, preventing PrEP from being used universally to treat HIV patients.
