Where Are We on World AIDS Day 2015?

78606771_thumbnailAre you familiar with PrEP, that strategy for treating people at risk for becoming HIV infected by using a combination medication marketed as Truvada? If you're like one-third of primary health care providers nationally, the answer is no, recent CDC data reveal.  And now, based on a study in NEJM Rick and I discuss on PodMed this week, it's even more critical that those at risk are offered the strategy.  That's because PrEP, which was proven successful in preventing acquisition of the virus in those at risk when taken on a daily basis, has now been shown to be effective when taken PRN.  Wow!  Not only does this make things more palatable for patients, it is also way less expensive.  This last is one of the primary barriers to use of PrEP among those offered the therapy.

The study results were as follows: "Of the 414 participants who underwent randomization, 400 who did not have HIV infection were enrolled (199 in the TDF-FTC group and 201 in the placebo group). All participants were followed for a median of 9.3 months (interquartile range, 4.9 to 20.6). A total of 16 HIV-1 infections occurred during follow-up, 2 in the TDF-FTC group (incidence, 0.91 per 100 person-years) and 14 in the placebo group (incidence, 6.60 per 100 person-years), a relative reduction in the TDF-FTC group of 86% (95% confidence interval, 40 to 98; P=0.002). Participants took a median of 15 pills of TDF-FTC or placebo per month (P=0.57). The rates of serious adverse events were similar in the two study groups. In the TDF-FTC group, as compared with the placebo group, there were higher rates of gastrointestinal adverse events (14% vs. 5%, P=0.002) and renal adverse events (18% vs. 10%, P=0.03)."

Well.  As Joseph Cofrancesco, an HIV expert at Johns Hopkins, has stated to me on multiple occasions, we have the power to stop this epidemic.  Now for the education, awareness, and political will to do so.  Other topics this week include two in JAMA: appropriate rate of C-section and how to manage obstructive sleep apnea, and in the BMJ, a critical look at methylphenidate in those with ADHD.  Until next week, y'all live well.

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