Irresponsible Journalism – PrEP for HIV

The New England Journal of Medicine today reported the results of a trial in which 2499 HIV-seronegative men or transgender women who were at high risk for HIV acquisition were enrolled to either receive daily emtricitabine plus tenofovir or placebo.  The results were that those who received the anti-retroviral medications had a 44% reduction in HIV incidence.

That should be great news right?  It is – why else is it published in the NEJM?  But I’m just a tad ticked off. Not at the people who performed the trial. Not at NEJM. But at the media. The news-stations and news websites blasting this information everywhere with the focus on anti-retroviral medications as the only answer to decreasing the acquisition of HIV.

Why? It is irresponsible journalism. 44% reduction is not 100% reduction. Prevention of HIV acquisition through sexual contact in 2010 still requires abstinence or the use of barrier protection. For those of us in the trenches there are too few HIV medications in existence for patients with HIV to use and too frequent incidences of drug resistances because of adverse reactions to these medications leading to patient’s intolerance or poor adherence. To spare TWO antiretrovirals for prophylaxis at this time may be premature.  Especially when you know from experience that the tendency of people at risk for an illness, any illness, is to opt for the easy way out – a magic pill (or two). Behaviour modification is too hard.

Don’t get me wrong. It will be fabulous when the time comes that we have a way to prevent HIV infection that does not involve an individual’s willpower. For example a daily medication or better a vaccine. As promising as this study is though, that time is not now.

Survival of the fittest still dictates that man will lose out to microbe. It’s the same story wherever you look in the field of infectious disease. So we should be cautious in adopting pre-exposure prophylaxis for HIV as exciting as the results of this study are.

Alas I fear those who do not take care of people living with HIV/AIDS will likely not understand how this sensationalist method of reporting the news is actually harmful and would interpret my post as insensitive.