Rumors are swirling about Truvada, the first drug approved to prevent HIV. Here’s what the research actually says about the safety and effectiveness of that famous blue pill.
On Thursday, President Obama signed an executive order laying out the national HIV/AIDS strategy for the next five years. The plan is fairly similar to the old strategy, with one big exception: It focuses on a pill that can prevent people from becoming infected with HIV.
The once-a-day pill, Truvada — used to prevent HIV in what’s known as pre-exposure prophylaxis (PrEP) — was approved by the FDA in 2012. When taken every day, studies show, Truvada reduces the likelihood of contracting HIV by 92%.
Since its debut, the drug has been heralded as the key to finally turning the tide on new HIV infections. Federal health officials have strongly recommended its use for people at risk of contracting the virus.
But Truvada is also riddled with stigma. Some associate the drug with a freewheeling promiscuity that forgets the devastating impact AIDS once wrought. As Out put it, Truvada is not only a little blue pill, it’s “a generation’s worth of fear and PTSD, coated in the promise of a new age of sexual freedom.”
That stigma has fueled further misunderstandings about how exactly the drug works, whether it’s safe, and who should take it. So while researchers and clinicians initially braced themselves for a swarm of interest, uptake of the drug has been slower than predicted.
The drug’s maker, Gilead, has so far tallied that only 8,512 people have been prescribed the drug for preventative use since it was approved. The real number is higher than that, as Gilead’s data comes from just 39% of U.S. pharmacies. Still, it’s far lower than the number of people who could benefit from the pill.
Which is why the Obama administration’s new push on PrEP matters.
“It acknowledges where progress has been made, but also where we need more,” Mitchell Warren, executive director of AVAC, a global HIV prevention advocacy group, told BuzzFeed News. “If the ambition of the new strategy is to reduce new infections, that’s not going to happen with business as usual.”
That also requires clearing the misconceptions still hanging over the pill, which while not perfect, has the potential to change the face of an epidemic. Here are six things science has taught us about PrEP.
1. PrEP isn’t a magic bullet, but missing a single dose doesn’t mean you’re screwed, either.
The big word here is “adherence.” Although PrEP is roughly 92% successful at warding off new HIV infections when taken properly, it’s hard to tell how many people will manage to stick to the once-a-day regimen recommended by the CDC.
The results of several year-long studies on adherence were revealed last week at the International AIDS Society meeting in Vancouver.
“We wanted to look at outside of a clinical trial and ask, when PrEP is provided in normal life settings, what is adherence like? Are people able to take the drug on a regular basis?” Albert Liu, research director of the HIV prevention program at the San Francisco Department of Public Health and the lead investigator on one of the studies, told BuzzFeed News.
Liu’s study, which will be published in the next few months, oversaw 300 patients — either men who have sex with men (MSM), or transgender women — visiting clinics in San Francisco, Miami, and D.C. The study provided one year of Truvada, along with STI testing, counseling, and clinical monitoring, in exchange for routine blood draws of the patients to see how well they were sticking to taking the drug.
After a year on Truvada, 63% of volunteers showed levels of the drug in their blood that consistently corresponded to taking it four or more times per week, the study found.
Although four times a week is lower than the CDC’s daily recommendation, studies have shown that it is enough to provide high levels of protection. Only two patients in the study contracted HIV, and both had blood levels that indicated they weren’t taking the drug at all.
“We do think that taking daily dosing provides the most forgiveness, and also fosters establishing a daily routine for taking the pills, which many people appreciate,” Liu said.
In other words, while a daily dose is still the best guarantee against contracting HIV, missing a single pill is most likely not going to hurt you.
Liu’s results also indicate that most MSM and trans women can effectively incorporate Truvada into their health routines.
For some, however, a daily pill just isn’t the right fit. “There are some people who aren’t going to adhere ever, and Truvada is not going to work for them,” Warren said. “And that’s why we still need other options.”
Other forms of PrEP are in development that might help with the adherence issue. Many of these match existing contraception techniques: a ring, injectables, and implantables. In the meantime, there are always condoms.
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