Barriers hinder wide use of HIV-prevention drug

The drug prevents up to 96 percent of new HIV infections.

It sounds like the answer to the prayers of those in danger of being infected, especially in Philadelphia, a national center for the epidemic.

So why isn't Truvada - the drug in question - used more often?

That was one of the issues discussed Wednesday at the 14th annual Prevention and Outreach Summit held by the HIV advocacy group Philadelphia FIGHT.

The meeting at the Convention Center attracted 1,200 people and covered topics from education to the perils of sex work. The Rev. Al Sharpton gave the keynote.

Truvada's appeal is that it prevents HIV from even taking hold in sexually active adults. This new approach is called pre-exposure prophylaxis, or PrEP. Truvada - a combination of two drugs, tenofovir and emtricitabine - prevents infections when coupled with other measures such as condom use.

Truvada was expected to get a boost when the FDA approved its use for HIV prevention in July, and sales rose to $3.2 billion in 2012, up 11 percent. But in this year's first quarter, sales fell by 8 percent, according to company filings.

Why? Taking a daily pill, covering the copay, and finding an accessible pharmacy were all identified as problems in focus groups. Though its maker, Gilead, may offer help with the copay, HIV largely afflicts the poor, for whom $50 a month may be too much.

Some patients may lack the inclination to prevent a disease they feel they will never get.

The drug's side effects are also reason for pause. The most serious include loss of kidney function and decreased bone density.

Primary-care doctors may be reluctant to give Truvada to uninfected patients because it would add the burden of regularly monitoring kidney function, said William R. Short of Jefferson University Hospital.

The summit coincided with new CDC guidelines for Truvada use in another group: intravenous-drug users. The guidelines are based on a trial of more than 2,000 people in Thailand, in which Truvada use halved the rate of HIV infection.

Teddy Robinson, 26, who represented the patient perspective on the Truvada panel, said he continued a relationship after learning that his partner tested HIV positive. He now takes Truvada daily.

"I was upset at first," he said, after his partner's disclosure. "But then I couldn't be upset because we had been using protection."

If Truvada were to become widely used, that might give people the false impression that condoms are no longer necessary, said Dr. Sarah Wood of Children's Hospital of Philadelphia. Condoms are still needed to prevent transmission of other sexually transmitted infections, such as chlamydia and gonorrhea.