HIV prevention pill pending approval in Canada

“Getting to Zero.”

That is the theme for the upcoming World AIDS Day in December. One of the continuing goals for the UNAIDS organization is to have zero new HIV infections.

Preventing HIV infection is no longer impossible thanks to a little blue pill.

The pill is Truvada. It is already used as a treatment for people who are HIV-positive. But it has been used for a HIV prevention method called PrEP – Pre-exposure Prophylaxis.

The pill is being prescribed for people who are HIV-negative as a medication to prevent HIV contraction. It is the only PrEP approved by health organizations like the Centre for Disease Control (CDC) and the World Health Organization (WHO).

“It is prescribed to you by a doctor. You take it everyday,” Sean Hosein, Science and Medicine Editor for CATIE, said. “It helps to reduce your risk of getting infected with HIV.”

Truvada is approved by Health Canada for HIV treatment but not as PrEP. However, willing doctors can prescribe it “off-label.”

This may change in the upcoming months as Gilead Sciences Canada, the manufacturer of Truvada, has applied to Health Canada for approval of the drug to be used as PrEP on August 2015.

Hosein said the unwillingness of Gilead in the past to apply for approval is one reason why the drug isn’t available as PrEP in Canada.

Truvada pill flask (Wikimedia Commons)

“The benefit (of Truvada approved as PrEP) would be that insurance companies would then add it to their formularies, the list of medicines subsidized,” said Hosein. Only the province of Quebec subsidizes the use of Truvada as PrEP. The pill costs $800 to $1,200 depending on pharmacy and region in Canada.

Dr. Ann Stewart, the medical director of Casey House, said she welcomes any HIV prevention method.

“Anything that we can do to prevent transmission and spread of HIV/AIDS is important to consider,” Stewart said. “For people who are at risk of exposure to HIV, I think (Truvada) is a reasonable precaution if they are regularly engaging in activities that are at risk for contracting HIV.”

Truvada was approved in July 2012 by the CDC to be used as PrEP in the United States. Last October, The WHO provided new guidelines recommending the use of PrEP to those at risk of contracting HIV.

But PrEP has received opposition. Michael Weinstein, the president of the AIDS Healthcare Foundation, called it as a “party drug” in a New York Times article. He said he’s worried that people won’t use condoms if they are on the drug.

Hosein disagrees. “PrEP is recommended together with condoms and other ways of protecting yourself from HIV,” he argued. “By taking PrEP, you’re not just taking a pill and go away and never come back to the doctor. You are getting tested. You are getting engage with care. People who want to use prep are taking steps so that they don’t get infected by HIV.”

“People need to know that taking medication always carries risks,” said Stewart, “Truvada is generally well-tolerated drug but there are some risks to the kidney if you are using it regularly. Also, there’s risk if you are not consistent with it to still contract HIV.”

As of 2011, there are 71,300 Canadians diagnosed with HIV/AIDS, according to the Public Health Agency of Canada, an increase of 11% since 2008. Meanwhile, approximately 17,980 remain undiagnosed.

Through 2011, HIV-related illness has been the cause of death for 24,300 people in Canada.

Asked if Truvada will make a big difference, Stewart said, “I don’t know but I’m willing to try.”