When Gladstone Institutes released evidence that Truvada, a one-a-day HIV pill, might prevent HIV in addition to treating it, the news sparked both excitement and skepticism.
The AIDS Healthcare Foundation (AHF), the largest HIV/AIDS medical provider in the country, came out against the use of Truvada for prevention, despite the fact that Gladstone's Iniciativa Profilaxis Preexposicion (iPrEx) trial showed the drugs to be more than 90-percent effective in preventing HIV in those who took it daily.
Experts on the study sat down with Feast of Fun podcasters Fausto FernÃ"s and Marc Felion at Center on Halsted June 15 to talk about what the study means and if Truvada could signal the end of the pandemic. Present were Dr. Robert Grant of Gladstone Institute, Keith Green, director of federal affairs at AIDS Foundation of Chicago, and a youth who participated in a similar study Green conducted in Chicago.
"In our wildest dreams, we did not think [Truvada] would be more than 90-percent effective in those who took it," Grant told the audience.
The findings also astounded Green, who halted Project PrEPare, a similar Chicago study, because he didn't want to continue administering placebos when he knew Truvada worked.
While the effectiveness of Truvada in preventing HIV is clear, the practicality of it remains uncertain. For one, Truvada is meant to be taken daily, which could pose a challenge to many not accustomed to the routine or whose lives don't always allow for consistency, such as youth living on the street. Additionally, Truvada is not without side effects including nausea, although that tends to go away over prolonged use, said Grant.
One barrier in getting people to use Truvada is stigma, Grant said.
"These pills, in particular, have been the one thing that folks want to avoid," he said, adding that fear surrounding HIV/AIDS contributes to fear around taking Truvada for prevention. "It strikes people as a misuse [of the drug]."
The drug could cost as much at $10,000 a year, an impossibly high price for people without insurance. In Illinois, the AIDS Drug Assistance Program (ADAP) which provides antiretrovirals to those who cannot afford them, is already cash-strapped. Truvada used for prevention could compete with Truvada treatments, creating a kind of Catch-22 for service providers who want to end the spread of HIV but also serve those who are positive already.
"We really have an ethical dilemma," Green said.
Still, many insurance companies are interested in Truvada for prevention because even with the cost of the drug, prevention is at least half the cost of treatment.
Rico, the youth who participated in Green's Chicago study on Truvada said that taking the drug made him "more considerate" of his body and protecting himself. He said that he had been hesitant to participate in the study but decided to sign up when he learned of the impact it could have on his community.
Grant and Green did acknowledge that iPrEx study had its shortcomings.
"I started to look at Dr. Grant's work, and those people didn't look like our people," Green said, adding that a low number of youth and African Americans had participated. Grant agreed and noted that their efforts would seek the expertise of Chicago service providers whose work included a diversity of clients. Still he added, the drug seemed to work equally well among people of every race.
As for AHF's critiques of using Truvada for prevention, neither Grant nor Green seemed to give them much weight.
"This is a large corporation, actually that has revenues above 300 million dollars a year, so well above my pay grade," said Grant, who went on to say that he was not certain about why AHF was working to discredit the trial results.
Truvada is awaiting FDA approval before it can be marketed for HIV prevention. Grant said that Gilead, the company that makes Truvada, will likely be hesitant to market the drug for prevention and that it will be up to AIDS service providers to make the leap in making Truvada more accessible.
For some, that leap can't come quickly enough.
"We either pay now or we pay forever," Grant said. "We have a chance now to stop this epidemic."