Peter Staley imagines how PrEP will be used in the years to come:
Women use contraception during periods of their lives when they believe they might need it. They can choose from a variety of options, from a daily pill to intrauterine devices, implantable contraceptives, patches, vaginal rings, and injections. PrEP will have the same future.
We just got a glimpse of PrEP version 1.1 from a European trial called IPERGAY. (Ah, those French, putting “gay” right in the trial’s acronym.) Instead of daily Truvada, trial participants have been taking intermittent, or on-demand, Truvada PrEP, consisting of two pills taken in the 24-hour period before anticipated sex and two pills during the two days after sex. The results thus far have been so dramatic, lowering HIV infections by approximately 80 percent, that the placebo arm has been halted early. Final results are due in early 2015.
He also notes that “PrEP 2.0 and beyond are in development, including an injectable that lasts three months.” In response to Staley, Bryan Lowder raises concerns about using PrEP intermittently:
PrEP, in Staley’s rendering, is something you pick up and use during periods of high and/or higher-risk sexual activity and then drop during fallow times or monogamous commitments. Clearly, this is one valid way to use the medical technology. But I do wonder how many people conceive of their sexual lives in such clear-eyed, pre-considered terms: Attraction has a way of surprising us, regardless of how we picture our situation, and, at least as it is currently administered, Truvada cannot just be snagged at the pharmacy on the way home from the bar. There is a kind of dissonance between the pitch that (for most people) PrEP is insurance for those random times when broader safer sex methods like condoms fail or fail to be employed, and Staley’s idea that it should function more like a limited-term, pre-planned diet. One wants lifelong insurance precisely because one cannot, generally speaking, foretell a season in which dental interventions will be more necessary or fender benders more likely.
The Dish thread on PrEP is here.