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

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Source – https://theconversation.com/

Women make up more than half of the people living with HIV around the world. Young women between the ages of 10 and 24 are twice as likely to get HIV as young men in the same age group. In East and Southern Africa young women will acquire HIV on average five to seven years earlier than their male peers.

Researchers have been working hard to find effective HIV prevention measures.

Most notable is the pre-exposure prophylaxis (PrEP) pill known as Truvada. This is a combination of two antiretroviral drugs – tenofovir and emtricitabine. This can be effective in preventing HIV acquisition. But taking a pill every day is not practical for many people.

Scientists from the HIV Prevention Trials Network recently found that a PrEP regimen of long-acting cabotegravir (CAB LA) injections once every eight weeks was better than the daily tablet used for HIV prevention. Ina Skosana spoke to Sinead Delany-Moretlwe, a research professor at the University of the Witwatersrand in South Africa and director of research at the Wits Reproductive Health & HIV Institute to find out more.

Can you tell us about the study?

This study, known as HPTN 084 is the first one to compare the efficacy of two HIV prevention or pre-exposure prophylaxis regimens.

The first regimen consisted of an injection of the long-acting antiretroviral drug, cabotegravir given every eight weeks. The second regimen was the daily oral dose of Truvada. Truvada has been shown to be highly effective for HIV prevention when taken as prescribed in a variety of populations and contexts.

We enrolled over 3,200 sexually active, HIV-uninfected cisgender women at 20 sites in seven countries. Research took place in Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda, and Zimbabwe between November 2017 and November 2020.

Our study randomised participants to one of two arms. One arm received active cabotegravir and a Truvada placebo. The other arm received active Truvada and placebos for cabotegravir. Cabotegravir was administered daily by mouth for 5 weeks and via intramuscular injection at 8-weekly intervals after an initial 4-week interval load.

What did you find?

Preliminary findings show that overall 1% of participants were infected with HIV during the study period. This suggests that both cabotegravir and Truvada are highly effective for HIV prevention in this population.

The 34 incident infections detected in participants assigned to Truvada is equivalent to an incident of 1.79%. And the four infections detected in the participants assigned to cabotegravir is equivalent to an incidence of 0.21%. This confirms a new prevention option for women that offers a significant advantage over existing oral PrEP which requires consistent daily use and is associated with significant adherence challenges.

We observed roughly 9 times the number of incident HIV infections in the Truvada arm compared to the cabotegravir arm. This finding suggests that cabotegravir is much more effective than Truvada in preventing HIV infection in women. And the threshold for early stopping of the trial was met. Based on these findings the independent data and safety monitoring board recommended that the blinded portion of the study be stopped early and the results released to the scientific and broader community.

An earlier sibling study in cisgender men and transgender women called HPTN 083  showed similar results. A prep regimen containing long-acting cabotegravir injectable once every 8 weeks was superior to the daily oral Truvada in that population.

What are the next steps?

The study results are important and timely as more methods to prevent HIV among women at higher risk of HIV are urgently needed. These include methods that do not depend on daily or near-daily pill-taking, condom use or abstention from sex. The development of alternative methods to prevent HIV, and more adherence-friendly schedules than are currently available, will increase the HIV prevention choices and acceptability for women and reduce new HIV infections.

We have communicated with the research ethics committees and national drug regulators overseeing this study, and site investigators and study participants are being notified about the results as soon as possible. Participants will be able to learn about the medication that they were receiving. A protocol amendment will be submitted for regulatory review to allow participants to continue taking their assigned medication or to switch to cabotegravir if they choose.

Participants on Truvada will be offered cabotegravir as soon as the medication can be made available. All participants will be asked to continue on the study. And if they chose not to remain on the study, they will be referred for the best locally available HIV prevention services. We look forward to presenting these results in a peer-review setting at upcoming conferences as we finalise the primary analysis.

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• Dehydration and vertigo
• How it happens
• Other symptoms
• Remedies
• Prevention
• Other vertigo causes
• Bottom line

Water is vital to our health and well-being. In fact, about 60 percentTrusted Source of our body weight is made up of water.

Dehydration happens when you lose more water than you take in. When this happens, your body doesn’t have enough water to effectively carry out critical tasks like breathing, digestion, and other essential functions.

Although you can become dehydrated simply by not drinking enough water, it can also happen due to:

• floating
• swaying
• tilting

When you experience dizziness or vertigo, you may also feel:

• nausea
• the need to sit or lie down
• worsening symptoms when you stand or move

However, it’s important to note that there are other conditions besides dehydration that can cause vertigo, such as inner ear problems and migraine.

You may be wondering why vertigo happens when you’re dehydrated. Let’s examine this in more detail.

When you’re dehydrated, your body doesn’t have enough fluids to function effectively. This can have an impact on many parts of your body, including your circulation.

People who are dehydrated often have reduced blood pressure or lower blood volume. When this happens, blood may not reach your brain in the way that it should. This can lead to feelings of dizziness or vertigo.

Most of the time, the dizziness caused by low blood pressure isn’t a vertigo-like feeling. Instead, low blood pressure due to dehydration typically causes a lightheaded feeling, like you’d pass out if it got worse.

But there may be instances where low blood pressure could cause the spinning sensation of vertigo. It’s just not as common as feeling lightheaded.

Some other dehydration symptoms to watch out for include:

• Thirst. Feeling thirsty is your body’s way of telling you that you need to drink more fluids.
• Reduced urination. When you’re dehydrated, your body will signal your kidneys to retain fluids. Because of this, you’ll likely urinate less frequently.
• Dark urine. If you’re well-hydrated, you urine is typically clear or pale yellow. Dark urine indicates that your urine has become more concentrated.
• Constipation. Your large intestine (colon) is responsible for absorbing water from your food. When you don’t have enough fluids, your stools may become harder and more difficult to pass.
• Dry mouth, lips, or skin. As your body loses fluids, you may notice dryness, flaking, and cracking of your lips and skin.
• Fatigue. Being dehydrated makes it harder for your body to carry out its normal functions. Because of this, you may feel lethargic or more tired than usual.
• Headache. Headache due to dehydration is pretty common. A small 2004 studyTrusted Source found that 1 in 10 study participants experienced headache due to dehydration. This was relieved by drinking water.

What should you do if you think your dizziness is caused by dehydration?

If you’re feeling dizzy due to dehydration, you can take the following steps to help ease your symptoms:

• Rehydrate. Try to replenish lost fluids as soon as possible. Focus on drinking water. Sports drinks or oral rehydration solutions can also be helpful for restoring lost electrolytes.
• Sit down. Move into a sitting position until your feelings of dizziness pass. When you begin to feel better, get up slowly.
• Move slowly. Remember that dizziness and vertigo can increase your risk of falling. If you must move, do so slowly. Try to hold onto something in case you lose your balance.
• Avoid certain activities. Some activities can be dangerous when you’re feeling dizzy. Avoid driving, operating machinery, or climbing up onto anything.

When to seek medical attention

There are some warning signs to watch out for that could be an indication that dehydration has become more serious. Seek immediate medical attention if you or a loved one:

• has a rapid heart rate
• feels confused or disoriented
• has trouble walking or moving around
• has diarrhea or vomiting that lasts longer than 24 hours

Severe dehydration can cause serious complications, such as:

• urinary and kidney problems
• seizures due to low levels of sodium and potassium
• heat exhaustion or heatstroke
• hypovolemic shock, a life threatening condition that’s caused by low blood volume

Dehydration can be treated in a hospital with intravenous (IV) fluids and electrolytes.

The following tips can help you stay hydrated throughout the day.

Get enough water

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, there are no specific recommendations on daily water intake.

However, according to the Mayo Clinic, drinking 8 glasses of water per day is a reasonable goal for most people.

Additionally, the National Academies of Sciences, Engineering, and Medicine notes that an adequate daily fluid intake is:

• 2.7 liters (91 ounces) each day for women
• 3.7 liters (125 ounces) each day for men

Your daily fluid intake doesn’t just include the water you drink but also fluids that you get from other foods and beverages, such as:

• fruits with high water content like watermelon, strawberries, cantaloupe, and oranges
• vegetables with high water content, such as lettuce, cabbage, and celery
• low-sodium broths and soups
• beverages like fat-free milk, herbal tea, juices, and sports drinks

Keep water on hand

Try to always have ready access to water. If you find that you often forget to hydrate, it may be helpful to make a habit of carrying a reusable water bottle with you.

Having water easily available is especially important when:

• you’re exercising
• the weather is hot or humid
• you’re doing anything to make you sweat more than usual

Hydrate more when you’re ill

If you become sick with fever, vomiting, or diarrhea, be sure to drink additional fluids. Don’t wait until you’re already feeling dehydrated to have a drink of water.

There are other potential causes of vertigo. Many of these causes involve problems with your inner ear, which helps control your sense of balance. Inner ear conditions that can cause vertigo include:

• benign paroxysmal positional vertigo (BPPV), a condition where changes in the positioning of your head can lead to brief periods of vertigo
• Meniere’s disease, a rare inner-ear condition that involves tinnitus and hearing loss
• labyrinthitis, an inflammation of the fluid-filled passages of your inner ear
• • vestibular neuritis, an inflammation of the vestibular nerve in your inner ear

  Other conditions that can also cause vertigo include:

  • migraine
  • stroke
  • multiple sclerosis
  • head injuries
  • brain tumors
  • certain types of medication, such as seizure and epilepsy medications and salicylates

One of the potential symptoms of dehydration is dizziness. You may feel lightheaded or woozy. In some cases, you may also feel as if you or your surroundings are spinning or tilting. This is known as vertigo.

If you’re dehydrated and dizzy, try to drink fluids right away. Carefully move into a sitting position to avoid falling. When your dizziness passes, be sure to get up slowly.

You can prevent dehydration by taking in fluids throughout the day. You’ll need to hydrate more during exercise, in hot or humid weather conditions, and when you’re sick. If you or a loved one is severely dehydrated, be sure to get immediate medical care.

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Hypertension or high blood pressure can be managed easily with simple lifestyle changes. Uncontrolled blood pressure can increase the risk of many health issues especially heart diseases. Many factors are associated with increased blood pressure. Poor lifestyle and dietary habits are some major contributors to high blood pressure. You should keep a constant check on high blood pressure to ensure healthy numbers. According to a recent study long working hours can also contribute to high blood pressure. The study published in the American Heart Association’s journal- Hypertension claims that long working hours can trigger high blood pressure in overworked employees. From working hours to dietary changes you can modify many factors affecting your blood pressure. Here are some healthy modifications you can make to control hypertension naturally.

Hypertension: Ways to control hypertension naturally

1. Exercise regularly

Regular exercise can help you reduce the risk of many health issues naturally. It can also help you control high blood pressure and boost heart health. Regular exercise will stop the development of high blood pressure. It will also control other factors that can contribute to increased blood pressure like being overweight. You do not have to spend hours at the gym for healthy blood pressure. A simple morning walk can also give you positive results.

2. Make necessary changes in your diet

The food you eat affects almost every process inside your body. Your diet also leaves an impact on your blood pressure. Adding some foods to your diet can result in naturally controlled blood pressure. Some foods which you can inculcate in your diet for healthy blood pressure numbers may include- yogurt, green leafy vegetables, bananas, oats, berries, seeds, olive oil and fiber-rich foods. You should also reduce your salt intake.

3. Manage stress

Stress can affect your health in various ways. Many day to day factors can contribute to increased stress. Stress can also put you at a higher risk of hypertension. If you experience too much stress throughout the day, make necessary changes to reduce blood pressure. Exercise, yoga and meditation can effectively control stress. If you have long working hours you must take small breaks to fight stress.

4. Quit smoking

The health hazards associated with regular smoking are quite popular. Smoking can also raise your blood pressure. If you are a regular smoker you must try to quit as soon as possible. If unable to do so, seek medical help to quit smoking.

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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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The Joint United Nations Programme on HIV/AIDS (UNAIDS) and its partners launched the 90–90–90 targets in 2014 with the aim of diagnosing 90% of all HIV-positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020. Despite considerable scaling up of ART across the world, 1.7 million people newly infected with HIV were detected in 2018. Eamonn Murphy, UNAIDS regional director for Asia and the Pacific, tells Sanchita Sharma why countries must retool programmes and focus on prevention, including scaling up pre-exposure prophylaxis (PrEP) for HIV-free persons at high risk of infection, and self-testing, to end AIDS. Edited excerpts:

Do you see the world meeting the 90-90-90 targets by 2020?

The simple answer is no. Some countries are doing extremely well, particularly in eastern and southern Africa. In Asia Pacific, we have a mixed but slowing response. A couple of big countries are holding us back with big epidemics; there are also some new epidemics. In the last nine years, there’s been only a 9% decline in new infections. Our progress is going backwards, that’s the real challenge.

Which are the countries doing well, and which are not?

Thailand is doing extremely well, as are Cambodia, Australia and Vietnam. But then we have the Philippines with a 200% increase in new infections in nine years, with a particularly steep rise in the last three or four years. Pakistan has had a 57% increase in the same period.

What led to the HIV outbreak in Larkana, Pakistan, this year, when at least 800 people were diagnosed with HIV, 80% of them children?

It was infection control procedures, mainly among general practitioners and local medical facilities. There were injection safety issues, including reuse of intravenous (IV) drips for saline to treat dehydration and diarrhoea in children, principally in the private sector and private blood banks. We’ve seen similar situations, but not in that scale, for example in Cambodia in the region, and globally. Pakistan quickly ordered a full investigation and scaled up testing to map it, which in a political world is a bold step.

How would you rank India on a scale of 10?

At seven, there’s been some slippage. In the Asia Pacific region [48 countries], Thailand is number one. Philippines was up there with Thailand; there was complacency and infection is back among the young in super high numbers. That’s the worry, it can happen elsewhere.

India has done a number of amazing things for the world and for its own population. Generic drugs have had the biggest impact globally to get people into treatment. Its focus on key populations (that spread infection), social contracting and putting the community first and equal in the response has been significant, but it needs to be rejuvenated. This is partly because of the lack of political will globally, regionally and at the country level, because AIDS is far from over. And at the rate we’re going, it’s going to start re-emerging in new geographic areas and new populations.

What are the new tools to stop new infection?

PrEP [pre-exposure prophylaxis] and self-testing are the two tools that really need to be scaled up. We’ve got to get prevention moving because we have a new generation that’s taking new and higher risks than the older generation that knew more about HIV. PrEP is an area India could seriously put in place; Australia saw 25% reduction (in new infection) after PrEP was rolled out there.

Should social media be used more actively for prevention messaging?

Yes. Programmes in all countries, including India, need to go through a prevention revolution. We need to retool and re-gear the programmes to target young people.

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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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Researchers have demonstrated the effectiveness of using algorithms that analyze electronic health records (EHRs) to help physicians identify patients at risk for HIV who may benefit from preexposure prophylaxis (PrEP), which significantly reduces the risk of getting HIV . The studies, which were supported by the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, advance a novel method that can help clinicians identify individuals most in need of PrEP. The two studies were published in The Lancet HIV.

“The development of innovative tools to increase PrEP use and adherence in the United States is crucial to our efforts to end the HIV epidemic,” stated Dianne Rausch, Ph.D., director of the NIMH Division of AIDS Research. “Identifying individuals who may benefit from PrEP is a major challenge for clinicians, and this is an important advance that could help improve PrEP delivery and use.”

PrEP is a strategy in which healthy people routinely take one or more antiretroviral drugs to reduce their risk of getting HIV. It is highly effective for reducing the risk of HIV acquisition, yet it remains greatly underutilized. The Centers for Disease Control and Prevention estimates that as many as 1.1 million Americans may be candidates for PrEP use—but, in 2016, only an estimated 78,360 (about 7 percent) were prescribed PrEP medication.

Physicians may underprescribe PrEP due to a lack of time or skills to adequately assess patients for HIV risk. In other instances, physicians may be unfamiliar with PrEP or consider it outside their purview to prescribe.

“The incorporation of automatic screening algorithms into EHRs could help busy clinicians identify and assess patients who may benefit from PrEP more efficiently, and empower them to prescribe PrEP more frequently,” said study author Douglas Krakower, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School.

In two large-scale studies, which used EHRs from large healthsystems in Massachusetts and California, researchers created and tested algorithms that analyze a rich array of health data and patient information to help clinicians automatically identify those at highest risk for HIV infection and therefore most likely to benefit from PrEP medications.

In the first study, Krakower and colleagues used machine learning to create an HIV prediction algorithm using 2007-2015 EHR data from more than 1 million patients attending Atrius Health, a large healthcare system in Massachusetts. The model used variables in the EHRs such as diagnosis codes for HIV counseling or sexually transmitted infections (STIs), laboratory tests for HIV or STIs, and prescriptions for medications related to treating STIs. The model was subsequently validated using data from 537,257 patients seen by Atrius Health in 2016, as well as 33,404 patients seen by Fenway Health, a community health center in Boston that specializes in providing healthcare for sexual and gender minorities, between 2011 and 2016. In these validation studies, the prediction algorithm was able to successfully distinguish between patients who did or did not acquire HIV, and between patients who did or did not receive a PrEP prescription, with high precision.

The researchers discovered many potential missed opportunities to prescribe PrEP. For example, more than 9,500 people in the 2016 dataset had particularly high risk scores from the prediction algorithm and lacked prior PrEP prescriptions.

According to Krakower, “A striking outcome is that our analysis suggests nearly 40 percent of new HIV cases could potentially have been averted had clinicians received alerts to discuss and offer PrEP to their patients with the highest 2 percent of risk scores.”

The second study, led by Julia Marcus, Ph.D., of Harvard Medical School and Harvard Pilgrim Health Care Institute, with Krakower and colleagues, scaled-up this prediction approach by using the EHRs of more than 3.7 million patients receiving outpatient services from Kaiser Permanente Northern California. They developed a model to predict HIV incidence using data from patients who entered the Kaiser Permanente system between 2007 and 2014, and they validated the model on data from patients who had entered the Kaiser Permanente system between 2015 and 2017. The model used variables in the EHRs such as high-risk sexual behavior indications, HIV and STI testing frequency, and STI diagnoses and treatments.

“Our model was able to identify nearly half of the incident HIV cases among males by flagging only 2 percent of the general patient population,” Marcus said. “Embedding our algorithm into the Kaiser Permanente EHR could prompt providers to discuss PrEP with patients who are most likely to benefit.”

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TOKYO

A new medication for treatment of the Human Immunodeficiency Virus (HIV) was placed on sale in Japan from April. But the government has been slow to approve other effective methods for dealing with HIV that have achieved favorable results in foreign countries.

To learn more about the current status of HIV/AIDS in Japan, Nikkan Gendai (June 28) met with Dr Shinichi Oka, director-general of AIDS Clinical Center at the International Medical Center of Japan in Tsukuba, Ibaraki Prefecture.

HIV carriers whose conditions go undiagnosed or untreated may eventually develop one or more of 23 afflictions, such as malignant lymphoma and others to which carriers are most vulnerable.

“What’s important is to begin a regimen of treatment before AIDS develops,” Oka is quoted as saying. “With the right treatment and support, people living with HIV can enjoy normal lives.”

Once a drug regimen is initiated, within three to six months the volume of HIV in the blood is reduced to “untraceable” levels. Use of a condom during sex is generally considered sufficient to prevent infecting one’s partner. Likewise the statistical likelihood of a pregnant female HIV carrier receiving treatment to transmit the HIV to her fetus is below 1%.

“There’s no chance of the virus developing resistance,” says Oka. “As in the past, missing one dosage won’t result in a problem. Moreover development is progressing with new drugs that will only need to be administered by injection once a month, or every other month.”

“In the case of Japan, some 30% of patient infections are diagnosed after the appearance of full-blown AIDS,” Oka points out. “There are certain areas where this phenomenon occurs more common than others. Over the past decade, the situation in Japan related to AIDS has not changed, and the number of new cases reported remains the same as before.”

The methodology for reducing the number of new cases is clear. The first step calls for early diagnosis of HIV and initiating a full treatment regimen. In Japan for some reason, this appears to be a high hurdle.

A free, anonymous blood test can only be conducted at public health offices, but people make various excuses for not going, such as “I can’t make the time.” (The offices are closed on weekends.) Or, “If people find out, I’ll be in trouble.” Or, “There’s a chance I’ll run into someone I know at the public health office.” And so on.

In many foreign countries, a number of test options are available such as diagnosis by mail using a saliva test kit — something that has yet to receive government approval in Japan.

Also available overseas is Truvada, a PrEP (an acronym for preexposure prophylaxis) prescribed to high-risk individuals. This has been strongly promoted by the World Health Organization and already approved in over 40 countries. But not Japan. If purchased out-of-pocket (without insurance coverage), a daily PrEP dosage costs about 3,800 yen; individuals who want it can purchase generic varieties online from overseas and it can enter the country legally as a “personal import.” But physicians are reluctant to recommend drugs that have yet to be approved and the average person cannot easily come by useful information.

“In many African countries with a serious AIDS problem, the number of cases has been reduced by half from the peak,” says Oka, who added. “In some parts of the U.S., Australia and Europe, where preventative medication is available, new cases have been drastically reduced.”

Japan, meanwhile, continues to cling inflexibly to two strategies: “Get a test at the public health office” and “Use a condom.” The data on new cases indicate that reliance on these is ineffective in reducing the contagion.

At the very least, Nikkan Gendai concludes, Japan should approve the simple and inexpensive saliva test and adopt the strategy of making preventative drugs available to high-risk individuals with multiple sex partners.

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