Trying a Pill to Prevent HIV

Jan. 20, 2009— -- In a massive medical trial on three continents, doctors are testing a controversial pill that could temporarily boost immunity against HIV before a person is even exposed to the virus. If the pill works safely, doctors must then address whether such a drug, if made widely available, could actually worsen the AIDS epidemic.

The pre-exposure pill undergoing testing seems promising, since HIV drugs taken within days after exposure to the virus have been shown to reduce the risk of infection by 80 percent. But public health officials debate whether people at high risk for the virus, such as men who have sex with men, would be more likely to set aside the use of condoms to instead rely on a drug regimen that doesn't provide full protection against the disease, which is spread by contact with the blood or semen of an infected person.

Dennis, a 47-year-old gay man from Atlanta, is one of the test subjects for the new pill. He calls himself "blessed" for escaping the HIV epidemic that hit many of his friends in the 1980s. But his HIV-negative status hasn't stopped him from having sex with infected partners.

"If you just say that you're not going to have sex with anyone who's HIV positive , here you're eliminating a whole bunch of wonderful people," said Dennis, who asked that his last name be withheld. "How shallow would that be?"

He was recruited for the clinical trial for PreP, or pre-exposure prophylaxis for HIV prevention, with a drug called tenofovir.

"I was eager to take it," said Dennis. Since he was already using condoms, he said, "It couldn't hurt. I'll know in June if I was taking the real McCoy, or if it was the fake pill."

Soon after he started the trial, he noticed the doctors were trying to study his behavior as much as the drug's side effects. Each time he went for a monthly checkup, HIV test and counseling, Dennis said the director of the study, Lynwood Miller at the AIDS Research Consortium of Atlanta, kept asking him about his sex practices.

"I don't think I was any more promiscuous just because I was taking the drug," he said. "I didn't put myself at risk just to test the drug. I'm not that crazy."