Daily HIV Prevention Pill (PrEP): Why It’s Urged for Healthy People at Risk

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LONDON, Aug 14 (Thomson Reuters Foundation) – Delays in rolling out an HIV prevention pill in England are putting gay men’s lives at risk, with thousands buying it online without medical supervision, HIV campaigners said on Wednesday.

England is lagging behind the United States and Kenya, where the highly-effective drug is more widely available, as health authorities only give the pills to gay and bisexual men taking part in a three-year clinical trial, which ends in 2020.

“This is a scandal,” said Will Nutland, co-founder of PrEPster, which is lobbying for the once-daily pre-exposure prophylaxis (PrEP) pill, also known by its drug brand name Truvada, to be offered in routine HIV prevention services.

“We have a technology that is cheap, accessible, is effective and is cost-effective, yet we’re still being denied full roll-out of this drug,” said Nutland, who is also a doctor.

“We know of people who have attempted to access PrEP and then have ended up being diagnosed with HIV three or six months later.”

Studies show that PrEP can cut by 99% the transmission rate of the human immunodeficiency virus (HIV) that causes AIDS. Some 340,000 people are taking it globally, according to New York-based advocacy group AVAC, 40% of them in the United States.

The number of places on England’s National Health Service (NHS) trial in January was more than doubled to 26,000 from 10,000 due to soaring demand, but no date has been set for a potential national roll-out.

Other regions in Britain have different policies. PrEP is available in Scotland through sexual health clinics.

A survey of almost 2,400 PrEP users in Britain published on Wednesday, by the UK’s public health agency and advocacy groups PrEPster and iwantPrEPnow, found that 54% got free pills via the English NHS trial and 37% bought them privately, usually online.

Some people are also buying PrEP informally through friends and contacts, while a private doctor’s prescription costs about 400 pounds ($482) a month, according to PrEPster.

The survey found that only half of those who paid for PrEP privately took the necessary kidney function tests before or while taking the pills, and nearly a quarter had to stop taking the drug because it was too expensive.

It is important to test for HIV and Hepatitis B before starting PrEP and to have regular urine and blood tests to ensure the drug is not damaging bones or kidneys, PrEPster said on its website, which advises on how to buy pills safely online.

“Despite the side effects of taking PrEP being minimal for many users, it’s vital anyone wanting to or currently taking PrEP has the relevant screenings,” said Liam Beattie, a spokesman for the Terrence Higgins Trust HIV charity.

Some 38 million people globally are living with HIV, with 1.7 million newly infected in 2018, according to UNAIDS, the United Nations’ AIDS agency. ($1 = 0.8293 pounds) (Reporting by Rachel Savage @rachelmsavage; Editing by Katy Migiro. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s and LGBT+ rights, human trafficking, property rights, and climate change. 

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I have lost count of the number of times I have heard women around me say “I don’t want to put hormones in my body if I can help it” when talking about contraception or trying to manage heavy periods, PMS or conditions like PCOS or endometriosis. But where does this fear come from?

Yes, there are many known side-effects to hormonal treatments (weight gain, skin problems, mood disturbance, gut issues) like the pill, and it can make some women feel awful. Others won’t feel anything. We also know that, because options are limited when it comes to women’s health (thanks to a systematic lack of funding for research), doctors often put women on hormonal medication in a leap of faith, hoping it will help. However, no two bodies will ever react in exactly the same way. It is important we remember that hormonal contraceptives can also be a godsend for some women – particularly as the wellness industry continues to expand and decry “traditional” medical intervention, a narrative that, if bought into, could potentially stop women finding relief.

I am about to try the combined pill again for the first time since I was 19, in an attempt to control cyclical pain (among other delightful symptoms) that is finally, after 12 years, being tentatively diagnosed as endometriosis – a condition for which the contraceptive pill is a first-line treatment option. I have tried all manner of hormonal interventions in the past – the Mirena coil, the mini-pill, oestrogen gel – in an attempt to control pain and psychological discomfort. I didn’t get on with any of them, but I strongly suspect that my subconscious aversion to taking anything “hormonal” had something to do with how I contemplated the experience. At this point I am willing to try what a kind, experienced gynaecologist suggests, because the pain gives me no other option.As Alexa Chung Shares Her Diagnosis, Here’s Everything You Need To Know About Endometriosis

The pervasive idea – that I bought into for some time – that our bodies should be as “pure” and “drug free” as possible is dangerous. In fact, I think it is one of the worst societal subtexts that pits women against each other. The common idea that there is nobility in being the woman who doesn’t need drugs; who’s had hardly any medical intervention; was the champion who gave birth drug-less, carries potential harm. The thought of there being women suffering with spirit-curdling pain each month and being dead-against taking a medication that might help because it isn’t “right” or “natural”, makes me very sad indeed.

The contraceptive pill is recommended by NICE as a treatment because it continues to have a good evidence base. Again, some women tolerate it better than others. Due to the huge differences in physiology from one woman to the next, we don’t know whether it will work for us until we try it. But trying what’s available to us is precisely what we should be encouraging women who are suffering to do – just as we should be encouraging basic diet and lifestyle changes. (Smokers have an increased risk of having bad period pain, for example.) If we are in pain and are well-informed about our options, nothing that has an evidence base should be off the table.

The language around this fear of hormones really interests me. We often reject the notion of putting “hormones” – the word imbued with a certain dirtiness – into our bodies… as if hormones aren’t what keep us alive. Perhaps it’s the idea of foreign agents – synthetic versions of what we naturally have that supposedly make us fat, mad and sad sometimes. But this growing fetishisation of “natural” – keeping our bodies as “clean” and pure as possible – has capitalised on our fears and been marketed to us as an ideal to make money from us.

There has been a powerful shift in the way women conceptualise and treat their health. According to figures from the Global Wellness Institute, the global wellness industry grew 10.6 per cent from 2013 to 2015: from $3.36 trillion to a $3.72 trillion market. It is easy (and sensible) to scoff at anyone in the wellness industry making dubious, cure-all claims, but we need to think about why these claims have so much power.

As many have argued, women in the Western world have created their own alternative healthcare system in clear response to being routinely dehumanised and dismissed by the medical establishment. Only, promises from wellness “practitioners” often have foundations of sand. “Clean” is a particularly pernicious term, for example, because while regulatory bodies have started to watch companies using “natural” as a marketing tool much more closely, “clean” is far more nebulous, less open to challenge.

There is no value in living in pain, no virtue in suffering. If we are encouraging women to be open about the realities of inhabiting their bodies, let’s encourage them to be properly informed, ask more questions from caregivers about what might help, and do away with this bogus idea of “purity”. A woman should be able to take whatever she has found gives her some peace of mind and body without feeling guilty.

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A popular diabetes drug sometimes taken to slow ageing may diminish some of the expected health benefits of aerobic exercise in healthy older adults, according to a new report. The drug, metformin, can blunt certain physical changes from exercise that normally help people to age well.

The results raise questions about the relationship of pills and physical activity in healthy ageing and also whether we know enough about how drugs and exercise interact. The results are particularly disconcerting given that healthy, active people may be considering taking the drug to slow ageing.

Metformin currently is the most-prescribed medication globally for people with type 2 diabetes. It allows people with type 2 diabetes to improve their blood-sugar control and insulin sensitivity, in large part by reducing the amount of sugar released by the liver into the blood. In people with diabetes, the benefits can clearly outweigh the risks.

But in recent years, scientists, physicians and plenty of other people entering middle age have become intrigued by the idea that it might also change how healthy people age. Worms and rodents given metformin typically outlive their unmedicated labmates. These animal studies suggest the drug not only reduces blood sugar, it also reduces inflammation and produces other cellular effects that alter aging.

Exercise also influences ageing, of course. Animal and human studies show, for example, that regular activity raises people’s aerobic fitness and increases their insulin sensitivity, both of which are linked with longer, healthier life spans.

Greater anti-ageing benefits

Unsurprisingly, some researchers have speculated that combining metformin and exercise might lead to even greater anti-ageing benefits than either approach alone. But little has been known about just how and whether metformin and exercise might work together deep inside our bodies and cells.

So, for the new study, which was published in Aging Cell, researchers at the Oklahoma Medical Research Foundation, Colorado State University and the University of Illinois decided to ask healthy people to sweat and swallow metformin. They began by recruiting 53 sedentary but otherwise healthy men and women in their early 60s. Most had risk factors for type 2 diabetes, such as a family history, but were not diabetic.

The researchers measured the volunteers’ current aerobic fitness, blood-sugar levels, insulin sensitivity and body mass. They also took tiny leg-muscle biopsies and randomly assigned the volunteers to start taking either metformin or a placebo. All of the volunteers then began a supervised exercise programme, visiting the lab three times a week to jog on a treadmill or pedal a bike for 45 minutes, a routine that lasted for four months.

Afterwards, the researchers repeated all of the measurements from the study’s start and compared the two groups.

It turned out, to no one’s surprise, that most of the volunteers now had better aerobic fitness and blood-sugar control than before, as well as improved insulin sensitivity. Each of these physiological changes would be expected to improve how well the volunteers aged.

But there were notable disparities between the two groups.

Overall, the men and women taking metformin gained less fitness, upping their endurance by about half as much as those swallowing the placebo. Many of those taking the drug also showed slighter, if any, improvements in insulin sensitivity. (Hardly anyone’s weight changed much, in either group.)

The scientists next looked microscopically inside their volunteers’ muscles and found telling discrepancies between the two groups. The muscle cells of the exercisers on placebo teemed with active mitochondria, which are the cells’ powerhouses. Mitochondria transform oxygen and sugar into cellular fuel in a process referred to as mitochondrial respiration. Higher respiration generally means better cellular health.

In the muscle cells from the men and women on placebo, mitochondrial respiration rose by about 25 per cent, compared to levels at the study’s start. But not so in the muscle cells from the metformin group, which showed little if any upswing in mitochondrial respiration.

Road-blocked

In effect, metformin had road-blocked the normal exercise-related gains in muscle-cell mitochondrial respiration, says Benjamin Miller, a principal investigator in the ageing and metabolism research programme at the Oklahoma Medical Research Foundation, who oversaw the study.

Without these souped-up mitochondria, the exercisers on metformin seemed less able to improve their fitness or insulin sensitivity than the other volunteers.

These results do not mean that people should stop or avoid using metformin, Miller cautions, even to brake ageing. The study followed only a small group of people for a relatively short period of time and examined a mere fraction of the voluminous bodily effects of exercise and metformin. It also did not include people taking metformin without exercise.

But the findings “do give us reason to think a bit more cautiously” about mixing metformin and exercise in healthy people, Miller says. “There was not an additive effect” from combining them, he says. Instead, metformin and exercise “did not seem to play together very well”.

More research is needed, though, to understand how metformin affects mitochondria, exercise and ageing, he says. More broadly, the results raise questions about how exercise might respond to other medicines. “Doctors are very cognisant of drug-drug interactions,” he says. “It’s time we consider drug-and-exercise interactions, too.” – New York Times

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MILWAUKEE — Kenneth Wade said he has always valued his health. He eats healthy foods. He works out. He drinks plenty of water.

In 2015, when some of his friends told him about a pill called PrEP that could prevent him from getting HIV, he said he felt that learning more about it was a natural and important step to taking good care of himself.

“My sexual health is part of my health,” Wade said. “I asked my doctor my questions about it, and within a week I was on PrEP.”

Wade, 27, is a new brand ambassador for the AIDS Resource Center of Wisconsin’s awareness campaign “Stay PrEP’d Up,” which seeks to educate Milwaukeeans about the benefits of the medication and break down any stigmas about it.

PrEP stands for pre-exposure prophylaxis. It’s a daily prescription pill that can significantly reduce a person’s risk of contracting HIV, a virus that damages a person’s immune system, makes it harder to fight off infections and can lead to AIDS.

When taken consistently, PrEP can reduce someone’s chance of getting HIV through sex by more than 90% and of getting HIV through needles by more than 70%, according to the Centers for Disease Control and Prevention.

After years of substantial declines, rates of HIV diagnoses have stagnated in recent years. Research from the Centers for Disease Control and Prevention suggests that this is because prevention options like PrEP are being severely underutilized.

“PrEP is the fast lane to the end of the AIDS epidemic, as long as we can make sure the people who need access to it are getting it,” said Mike Gifford, president and chief executive officer of the AIDS Resource Center of Wisconsin.

In cities like Milwaukee, there are huge disparities in who is impacted by HIV, along with who accesses PrEP. African American gay and bisexual men are more affected by HIV than any other group, with Latino gay and bisexual men being the second most impacted group, according to the Centers for Disease Control and Prevention.

In 2017, 83% of the 118 new HIV diagnoses in Milwaukee were among people of color, according to the AIDS Resource Center of Wisconsin. Research from the Medical College of Wisconsin indicated that African American men are diagnosed with HIV at rates four times higher than white men.

Meanwhile, the Centers for Disease Control and Prevention reported that only 1.4% of African Americans and 2.5% of Latinos who could have potentially benefited from PrEP were prescribed it.

“If we don’t find ways to increase PrEP use to young people of color, we’re going to continue to see those disparities,” said Katherine Quinn, assistant professor at the Medical College of Wisconsin’s Center for AIDS Intervention Research.

PrEP is a good option for people who are HIV-negative but who face a higher risk of getting HIV, Quinn said. Factors that may heighten a person’s risk of getting HIV are having sex with someone who is HIV-positive, having sex within a social network where HIV is more common, having had sex without condoms, having multiple sexual partners or exchanging sex for drugs, food, money or a place to live, according to the Stay PrEP’d Up website.

Wade said he was initially hesitant about taking PrEP because he wasn’t sure if his insurance would cover it. But after doing some research, he learned that his clinic could make it affordable.

“I have found it very easy for me to get treatment,” Wade said.

Besides possible financial barriers, Wade said he has heard about stereotypes or misunderstandings that have made some of his peers skeptical of PrEP. For example, he said some people thought that the PrEP pill was for people who were HIV-positive, and that people would judge them if they took it.

“It’s really just about being safe and protected,” he said he wants others to know. — (AP) 

___

The nonprofit news outlet Milwaukee Neighborhood News Service provided this article to The Associated Press through a collaboration with Institute for Nonprofit News.

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