Tuesday, June 15, 2010

PrEP - New Treatment or Drug Company Hype?

If you haven't heard of PrEP you are probably not gay or scientifically curious. No matter, you will no doubt hear of it soon..

PrEP stands for pre-exposure prophylaxis and it is the subject of quite a bit of research in the HIV/AIDS field. The theory goes that if you take antiretroviral drugs even though you are HIV negative, you will reduce your chance of getting the disease. Animal testing is promising, but the sticky problem goes far beyond anything that can be tested in lab rats.

Research has found that gay men, when given the chance to take a drug regimen that might be 80% effective, indicate they would be much more likely to stop using condoms. This means riskier behavior and unprotected sex.

Furthermore many of the men who were surveyed are regular users of "club drugs", and we all know how rational decisions work when you are high! The backlash of PrEP is something researchers call "risk compensation". In other words men taking the antiretrovirals feel riskier behavior is less of a problem and so they do it.

At a time when the infection rates of HIV are rising among gay men because of unprotected sex, this really raises a red flag for me. I understand that is intended to save lives, but I have a nagging feeling in the back of my head it could lead to a whole range of unintended consequences.

The first one is drug resistant strains of HIV. Just as prophylactic use of antibiotics has lead to drug resistant infections like Methicillin-resistant Staphylococcus aureus (MRSA) this kind of widespread use of antiretrovirals could lead to still more virulent HIV strains.

Second, and something I suspect is really driving these tests is profit. The drug companies realize that marketing their drugs to HIV+ individuals limits the market, and since even though life expectancies have increased, AIDS is still deadly no matter what the marketing hype says. Faced with a shrinking or limited market, they want to sell more drugs, so why not sell them to everybody whether you need them or not? Now you have a huge market and what once was a niche drug is now the hottest thing since Viagra.

Call me cynical? Yes I am. I have watched the pharmaceutical companies glamorize HIV/AIDS and try to position it as a "manageable condition" much like Diabetes. Bullshit! You can manage it until the drugs stop working or you run out of money, which ever comes first. Then you disappear from their radar and begin the process of succumbing to the disease. David Webb spoke of this in last weeks Dallas Voice and he was speaking the cold hard ugly truth. HIV/AIDS is a life threatening disease. It isn't pretty or sexy or cheap. It changes your life from carefree to a carefully controlled regimen of drugs and tests and jumping through insurance company hoops. So I am a bit skeptical when something like this comes along.

Will PrEP be a blessing or a curse? Well I think finding a cure for HIV would be more valuable than finding a way for people to have riskier sex. I sincerely believe the drug companies concentrate on treatments instead of possible cures simply from the economics of it. Cure the disease, your product becomes obsolete. Treat the disease; you can milk your market forever.

1 comment:

Anonymous said...

"You can manage it until the drugs stop working or you run out of money, which ever comes first. Then you disappear from their radar and begin the process of succumbing to the disease."

Sometimes I think I'm just a guinea pig, all in the name of private company research. In my case being hiv+, I am "over medicated" to the point my t-cells are so high I am like anybody who is hiv-.

I am treated by VA, so it's not a matter of money. Sometimes the drugs stop working, but that's because of irregular use or a type of hiv which is resistant to the drugs, so other regiments are used.

Currently I my t-cells are 1039, and am completely undetectable. But the consequence of too many drugs are the side effects. I'm experiencing strange things now happening that never happened before.

I had always been slim, now I'm suddenly 100+ pounds overweight (almost 300pds!) and still gaining (even with a fasting diet and exercise!), my blood pressure has always been exceptionally healthy and low, but now I have high blood pressure, extreme pain throughout my body, seeing difficulties, a cyst was just discovered on my kidney, and I may have problems with an overly big spleen now. I will am asking, even pleading for a change in my regiment. If I don't get a change so these side effects stop happening, I'm quiting my regiment just to return to normal levels, even if it means lowering my t-cell count.

It's not unusual that the very medicines that help cure or keep alive a person, will ultimately kill that same person. :(

richard h.
fort worth, texas, usa