Tenofovir helps prevent HIV in drug usersBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3871 (Published 18 June 2013) Cite this as: BMJ 2013;346:f3871
A team of researchers from Thailand and the US has shown for the first time that tenofovir can help prevent HIV in injecting drug users. Daily prophylaxis cut incidence by about half in a placebo controlled trial of 2413 drug users attending treatment clinics in Bangkok (0.35 v 0.68 per 100 person years; reduction 48.9%, 95% CI 9.6% to 72.2%). All participants received a package of prevention measures including counselling, condoms, methadone options, and regular HIV tests. The protective effect of tenofovir took three years to emerge, a result the authors found hard to explain. Rates of infection were lower than expected.
The trial was independently funded. It fills an important gap in the evidence for pre-exposure prophylaxis against HIV, says a linked comment (doi:10.1016/S0140-6736(13)61140-X). We know antiretroviral drugs help reduce sexual transmission of HIV and transmission from mother to child. Public health authorities can now add drug users to the list of potential beneficiaries and think about adding pre-exposure prophylaxis to other strategies that are known to work, such as needle exchange programmes.
Did daily tenofovir prevent parenteral transmission of HIV? Possibly, says the comment. But it’s hard to say how much. Treatment may have reduced sexual transmission in drug users too.
Cite this as: BMJ 2013;346:f3871