Tuesday, March 28, 2006

Medicine: Taking a T works for monkeys

In one of the Sparkgrass outtakes from December, I ran across an article in the LA Times (that article seems to be unfindable at this point somehow) about some apparently some gay folk who were a little less than interested in the safest of safe sex practices were "taking a T," or taking prophylactic doses of tenofovir, an NtRTI currently used as part of the HIV prevention cocktail for folks who, say, stick themselves with a needle in a hospital.

Turns out, this approach might actually show some promise.

Of course, the logical debate arises whether the availability of tenofovir cocktails as prophylaxis would lead to an increase in safe sex practices. Given that the target population for this cocktail is a group that already tends to practice lax safe sex practices, I don't think that anti-T argument holds water on a grand public health scheme. Of course, some individuals may choose to forego the condom they might otherwise use, but it sounds like these folks are already planning to address that issue as well as possible:

People like Matthew Bell, a 32-year-old hotel manager in San Francisco who volunteered for a safety study of one of the drugs.

"As much as I want to make the right choices all of the time, that's not the reality of it," he said of practicing safe sex. "If I thought there was a fallback parachute, a preventative, I would definitely want to add that."

Some fear that this could make things worse.

"I've had people make comments to me, 'Aren't you just making the world safer for unsafe sex?'" said Dr. Lynn Paxton, team leader for the project at the Centers for Disease Control and Prevention.

The drugs would only be given to people along with counseling and condoms, and regular testing to make sure they haven't become infected. Health officials also think the strategy has potential for more people than just gay men, though they don't intend to give it "to housewives in Peoria," as Paxton puts it.
And then the next issue, drug resistance with monotherapy for prophylaxis. Would taking a T just lead to tenofovir-resistant (and possible multi-drug resistant) HIV strains? Would the addition of more drugs in a cocktail decrease this chance? Given that I'm not particularly educated on the mechanisms of viral resistance in a situation of very low viral load exposure, I wouldn't be comfortable having an opinion either way. But I bet the risk is significantly different that the use of anti-bacterial antibiotics.

It all seems to be working great for the monkeys, at least. God knows we don't need a bunch of HIV-positive monkeys running around.

Further research question: synergy between reverse transcriptase inhibitors and bananas?


michael said...

call me stupid but i don't see how taking expensive medication on a regular basis is an advantage over using an inexpensive condom on a regular basis.

Garrett said...

from whose perspective? the gay dude, public health, or monkeys? i think is designed for meth-a-matics who will have no clue what a condom is when it comes time to insert. or some people who want au natural hell or high water might at least have some protection rather than zero.

sure a condom is cheaper. but it doesn't work well in the package.