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editorial | TRUVADA AS PREVENTION

A quiet breakthrough on HIV

Thirty years into the battle against HIV, medical researchers still haven’t discovered a cure or a vaccine. But the Food and Drug Administration’s recent approval of a new use for the antiretroviral drug Truvada marked a quiet breakthrough that could bring them closer to that goal.

Clinical trials, including some that took place at the Boston HIV research center Fenway Institute, have shown that Truvada, which is primarily prescribed to suppress the virus in people who have HIV, can significantly reduce the likelihood of new infections in HIV-negative people. The FDA’s approval clears the way for doctors to prescribe Truvada to those who are at high risk, such as young gay men, black women, and HIV-negative people in relationships with HIV-positive partners. The latter group may prove to be the most common users of the drug; while these couples shouldn’t stop practicing safe sex, because Truvada does not eliminate the risk, the existence of an additional form of protection should set their minds at greater ease.

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As treatments and prevention methods have advanced, the greatest challenge to curbing HIV-transmission rates has been social, not medical. Infection rates grow when people who don’t know they’re infected continue to engage in risky practices, and when those who know they’re infected lack the money to seek treatment or the social stability to take medications consistently. The pill’s success at lowering HIV transmission rates will depend on the medical community’s ability to use it in the face of these persistent social problems.

Here in Massachusetts, Harvard Pilgrim Health Care has agreed to cover Truvada as a preventive medication for about $25 per month for patients. The state’s other insurance providers should follow suit. Doctors must also be prepared to recommend the drug, but also to stress that it has side effects and should still be paired with other preventative measures. The overall effects of Truvada will most resemble that of a cure only if those who take it understand it isn’t one.

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