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New PrEP Trial Results Among Injecting Drug Users Underscore That PrEP Works When Taken Consistently
Date:6/12/2013

and transgender women who have sex with men. In July 2012, the US Food and Drug Administration (FDA) approved daily oral TDF/FTC (marketed as Truvada) for HIV prevention for all adults at risk of HIV from sexual transmission based on data from several PrEP trials that evaluated TDF/FTC for PrEP. Only one other PrEP study—Partners PrEP, which enrolled serodiscordant couples—evaluated daily oral tenofovir disoproxyl fumarate (TDF, marketed as Viread), as well TDF/FTC. It will be critical to examine the cost and feasibility of both daily TDF and TDF/FTC in light of these new data.

The Bangkok Tenofovir Study, which was conducted by the US Centers for Disease Control and Prevention (CDC), the Bangkok Metropolitan Association and the Thailand Ministry of Public Health, found that a daily dose of the drug tenofovir reduced the risk of HIV infection by 49 percent overall and at a higher rate (up to 74 percent) among trial participants who had detectable tenofovir in their blood, an indication that they were taking the drug consistently. The study, which began in 2005, enrolled more than 2,400 men and women who were part of a drug treatment program run by the city of Bangkok.

The trial team states the conclusion that the HIV infections that occurred were primarily the result of injection drug use, rather than sexual exposure. The team also reports consistent decreases in reported risk behaviors including injection drug use, needle sharing and unprotected sex in both study arms; also of note, the preventive benefit was only observed after the first three years of follow-up.

"People who use drugs also have sex, and there is no way of distinguishing between infection acquired via sex versus drug use. This is one reason why this PrEP strategy cannot be viewed as a replacement for proven prevention such as syringe exchange and drug substitution programs that specifically reduce risk of HIV via drug use. All countries
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