Healthy Living: December 4, 2018

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BANGOR, Maine (WABI) - December 1st was World Aids Day, yet many of us have become more complacent about this since 1981 when the first cases of HIV/Aids were recognized. Initially, contracting this virus was akin to receiving a death sentence, and all that health-care workers could offer was preventive education and testing. But with the significant success of research into antiviral treatment during the 1990's most individuals can lead normal lives if they remain compliant with their anti-HIV medication. Still, it remains a serious public health problem. There are an estimated 40,000 new cases per year in the US alone, and it is the 9th leading cause of death for younger adults between 25 and 44.

Most of us are aware of the standard advice on how to prevent HIV/Aids transmission using safe sex techniques, which for most means condom usage. However, since 2012, the FDA has approved usage of a medication to be taken on a regular basis by HIV negative individuals who have exposure to the virus, either through sex or using injection drugs. This pre-exposure prophylaxis or 'PreP', as it is commonly called, is the promise of an antiviral combination medication marketed as Truvada. In May of this year, the FDA extended the ages those who could safely use the medication to include at-risk teens down to age 15.
How effective is this medication? First, a person needs to have it in their system for about 3 weeks to get maximum protection and then be compliant with once daily usage as long as one is having potential exposure. And it is not perfect: according to the CDC its use can result in a 92% risk reduction for those with unsafe sex practices, but only a 70% risk reduction for those using injection drugs and sharing needles. HIV/Aids advocates would want to remind everyone that using the medication should not give a person the false sense of security that they might stop safe sex practices. However, another important use may be for couples where the man is HIV positive and they want to conceive a child. In this setting the woman could take Truvada until conception and then return to condom usage afterward. Some experts advise that it be considered for long term use in any relationship where one individual is HIV positive and the other is not.

So, what are the downsides? Well, it is fairly well-tolerated, though some do experience nausea, abdominal pain or headache. There are some rare kidney toxicities, as well as adverse effects on bone health for individuals on long term therapy, and physicians may recommend periodic renal function tests or bone-density testing But cost remains a significant deterrent for many. Although most pharmacy plans will cover this, there can be very high co-pays. Without any insurance, the cost will run about $2000 per month, however the manufacturer does have a program to assist those individuals who cannot afford the medication.
Still, the advice of the US Preventive Services Task Force might be the best last word: They advise that testing should be offered to all so that individuals would be aware of their HIV status, as well as the status of their partners. Also, couples not in a long-term monogamous relationship should practice safe-sex with condom use. Last, if a person is at higher risk with partners of uncertain HIV status, or if their partner was known to be HIV+, then Truvada should be recommended to prevent transmission of this serious and still deadly disease.