CDC Recommends Truvada for HIV Prevention

Federal health officials indicated a shift in the ongoing fight against HIV and AIDS when the CDC announced Wednesday new clinical guidelines that encourage the use of pre-exposure prophylaxis, or PrEP.

The Centers for Disease Control and Prevention Wednesday announced new clinical guidelines that recommend anyone who is at an elevated risk for contracting HIV use the drug Truvada as a preventive measure to help protect themselves from being infected with the virus, which can cause AIDS.

The federal health agency recommended the use of Truvada,, an antiretroviral medication that is also used to treat HIV, as a form of pre-exposure prophylaxis, of PrEP, for gay and bisexual men who have sex without condoms, anyone who regularly has sex with partners who are HIV-positive, intravenous drug users or anyone who shares needles, and heterosexuals partnered with high-risk individuals, including IV drug users and bisexual men who have sex without condoms.

The CDC's guidelines still recommend that PrEP be used in conjunction with safer-sex practices, including the use of condoms, though some acknowledge the likelihood of that is low. While Truvada can help prevent HIV infection, eschewing condoms still puts an individual at risk for other sexually transmitted infections, including syphilis and gonorrhea.

"Making the perfect the enemy of the good is something we’ve got to get over," Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and the country’s best-known AIDS doctor, told The New York Times. "I strongly support the CDC doing this."

According to the Times, the new guidelines, if followed, could have a ripple effect on the way Americans fight HIV and AIDS, shifting the conversation around prevention from focusing on condoms to focusing on use of the antiretroviral drug. The Times notes that strict adherence to the guidelines would result in "a 50-fold increase in the number of prescriptions for the drug … to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year, and most insurers already cover it."

Truvada, which has been used to treat HIV-positive individuals since 2004, was approved by the Food and Drug Administration as a tool to prevent HIV in 2012, after studies revealed a 75 percent success rate in preventing new infections in serodiscordant couples (where one partner is HIV-positive, the other HIV-negative) who used the drug correctly. Another study of gay men showed that 99 percent of those who took the medication daily as prescribed were protected from HIV. Although the daily, one-pill regimen has been proven to reduce the risk of HIV transmission, it must be taken consistently.

Truvada, manufactured by Gilead, is a mix of tenofivir and emtricitabine and is generally considered safe. During clinical trials of its use as PrEP, some people said they experienced diarrhea, nausea, abdominal pain, headache, and weight loss. A small segment of users experienced kidney problems.

Despite its efficacy, the use of Truvada as PrEP has been dogged by controversy, with detractors claiming the drug will lead to unsafe sex practices, even spawning the phrase "Truvada whore" to describe someone who takes the drug to have guilt-free sex without condoms. Some advocates, however, are already working to reclaim the term, wearing T-shirts with the hashtag #TruvadaWhore in an effort to stop what they call "slut-shaming" of those who use PrEP.

Last September an article for The Advocate's sibling publication Out asked of the drug, "Is This the New Condom?" Writer Tim Murphy spoke to advocates who compared the impact of PrEP on HIV to the impact of the birth control pill on unwanted pregnancies in the 1960s. The article sparked a storm of controversy as readers argued over the pros and cons.

A recent op-ed published at The Advocate makes the case for use of Truvada as protection. Writer Antonio David Garcia refuses to be shamed out of taking PrEP:

"Some critics say Truvada is a 'party pill,' outrageously equating it with recreational drugs, and that those who use it will have more unsafe sex and higher rates of HIV. To be sure, some gay men will use Truvada without condoms. Some gay men will choose not to wear condoms nor take Truvada at all. Being on an effective PrEP regimen is a good thing, and Truvada is another tool in the toolbox to protect yourself from HIV. So I’m going to take it."

For more information about Truvada, check out the resources gathered by another of our sibling publications, HIV Plus Magazine.