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Once-a-week Prep dose to prevent HIV

medworx update …

 

Researchers have developed a once-a-week pill to prevent HIV. The drug will take years before it is available, because it has to go through lengthy trials.

This would be a welcome alternative to the pre-exposure prophylaxis pills available in most countries including Kenya, which must be swallowed daily.

In May last year, Kenya became the second country in Africa, after South Africa, to roll out Prep.

But uptake has been slow partly because healthy individuals have to take pills daily. The new drug, code-named MK-8591 or EfdA, has been developed by medicines manufacturer Merck.

Read: Kenya takes lead in approving daily oral pill to lower chances of getting infected with HIV research presented at the just-ended Conference on Retroviruses and Opportunistic Infections in Boston, USA.

The drug can stay in the body for more than five days, which makes it suitable for weekly dosing. Researchers said it is 97 per cent effective on monkeys, but this effect may not be replicated in humans.

Past review of studies where medical interventions were tested on animals showed only 37 per cent were replicated in subsequent human randomised trials.

“Monkey studies suggest one small weekly pill could easily be effective as Prep,” said Martin Markowitz of New York’s Aaron Diamond AIDS Research Centre.

“The original dose was equivalent to a 41-fold reduction in HIV, in other words, about a 97.6 per cent efficacy in reducing SHIV (monkey HIV) infection.”

Merck’s Randolph Matthews said it has already been tested in humans just to establish the right dose.

Currently, the National Aids and STIs Control Programme is targetting 80,000 Kenyans with Prep in a year.

The daily pills are available for free in public health facilities.

“Anyone who is at continuous risk of infection is eligible. You can just walk into a government health facility and request the pill. But they will assess you to check if you’re eligible,” said HIV researcher and former Nascop boss Martin Sirengo.

Nascop has not released uptake figures, but the Prep popularity has been hampered by the fact users have to swallow a pill daily.

Sirengo said the government first targets discordant couples, where one partner is HIV-positive and another is HIV-negative; people who frequently contract STIs; individuals who are unable to negotiate condom use; people who regularly use Post Exposure Prophylaxis and drug users who share syringes. “It is highly effective and will be given to those that are at risk of contracting HIV,” Dr Sirengo said.

 

Sarah Blake-van Niftrik

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