What if there were a pill that could help prevent HIV?
It’s called pre-exposure prophylaxis (PrEP), a daily pill to reduce risk of HIV infection, and it is in use at Baystate Medical Center right now.
“We’ve come a long way since the early days of AIDS, when the epidemic started in the mid- to late 1970s. Back then a diagnosis of AIDS was considered a death sentence. Today, thanks to research and the development of new medications such as antiretroviral drugs, HIV has become more of a chronic illness for which treatment can offer many patients a long, healthy, more productive life,” said Dr. Daniel Skiest, chief, Infectious Diseases, Baystate Medical Center.
World AIDS Day, observed every year on December 1, is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV, and to commemorate people who have died.
Education remains one of the most powerful tools in the fight against HIV/AIDS, education that includes what options are available for treatment, such as the use of Truvada for those at high risk of getting HIV, noted the Baystate HIV/AIDS expert.
Truvada is a combination of two drugs (tenofovir and emtricitabine). If you take PrEP daily, the presence of the medicine in your bloodstream can often stop HIV from taking hold and spreading in your body.
“Several studies have shown that the risk of getting HIV infection was dramatically lower, as much as 92% according to claims from the CDC. But, that is for those who take the pill consistently. Those who skip taking the medication on a daily basis may not have enough medicine in their bloodstream to block the virus,” said Dr. Skiest.
Dr. Skiest and the CDC recommend that PrEP be considered for people who are HIV-negative and at substantial risk for HIV. For sexual transmission, this includes anyone who is in an ongoing relationship with an HIV-positive partner. It also includes anyone who is not in a mutually monogamous relationship with a partner who recently tested HIV-negative, and is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection, such as those who inject drugs or have bisexual male partners.
Also, PrEP is recommended for those who inject drugs, including individuals who have injected illicit drugs in the past six months, and who have shared injection equipment or been in drug treatment for injection drug use in the past six months. For heterosexual couples where one partner has HIV and the other does not, PrEP is one of several options to protect the uninfected partner during conception and pregnancy.
“PrEP is always prescribed as part of a comprehensive HIV prevention strategy including the use of condoms, general safe sex practices, adherence counseling, frequent STD testing and follow-up visits,” said Dr. Skiest.
An estimated 34 million people are living with HIV worldwide. According to the CDC, some 1.2 million people in the United States are living with HIV – and nearly one in eight of them are not aware that they are infected.
HIV/AIDS takes a disproportionate toll on African American and Black communities, accounting for over half of the estimated number of HIV/AIDS diagnoses made. In Massachusetts, Black residents make up 6% of the state’s population, but represents over 28% of Massachusetts residents living with HIV/AIDS – a rate 11 times higher than the white population. Latinos represented 16% of the population, but account for some 20% of new HIV infections.
Around the country, including in Massachusetts, HIV positive people are being diagnosed with AIDS within two months of learning they were HIV positive.
“The significance of this fact is that people are being diagnosed late in the disease, which leads to higher morbidity,” said Dr. Skiest.
He noted there are many ways individuals can take action in response to HIV/AIDS including:
• Getting tested for HIV.
• Practicing safer methods to prevent HIV.
• Deciding not to engage in high risk behaviors.
• Talking about HIV prevention with family, friends and colleagues.
“HIV testing is a critical step in the prevention of HIV, but just as important is what happens after the test,” said Dr. Skiest.
HIV medical care and prevention counseling can improve health and increase survival and prevent the spread of HIV. Most people with HIV receiving care are given medicine (antiretroviral therapy, ART) that lowers the amount of the virus in the body. In fact, 77% of patients given ART have very low amounts of the virus in their bodies. Low amounts of the virus in the body leads to improved health and much longer lives for people with HIV and can help prevent the passing of the virus to others.
“Yet, only half of people with HIV are in the care of a doctor and only 28% have their virus under control,” said Dr. Skiest.
Baystate Medical Center, in association with its neighborhood health clinics – Baystate Mason Square Neighborhood Health Center, Baystate Brightwood Health Center, and Baystate High Street Health Center – is the largest provider of HIV care in Western Massachusetts. The Baystate HIV program offers services for HIV infected children and adults, including HIV testing and prevention counseling, outpatient and inpatient medical care, social services coordination and clinical research trials.