A treatment that's being billed as a big breakthrough in AIDS is prompting a very uncomfortable question: How much are we willing to pay to prevent people from becoming infected with HIV?
Scientists at San Francisco's Gladstone Institutes announced that gay men and some transgendered women who took a daily pill called Truvada were 73 percent less likely to become infected with the virus. The study was published in the New England Journal of Medicine today.
"This is a very exciting, dynamic time in HIV prevention research," Alan Bernstein, head of the Global HIV Vaccine Enterprise, a non-profit, tells USA Today. "It couldn't come at a better time. There's clearly a growing realization that we're not going to be able to treat our way out of this epidemic."
But that promise comes at a cost.
Truvada, made by Gilead Sciences of Forest City, California, is already sold to treat HIV infections at a cost of about $36 a day. That can add up to $13,000 a year, although there are cheaper, generic versions available overseas.
David Paltiel of Yale University tells USA Today that his research shows that Truvada could be as cost-effective a prevention method as those used to combat heart disease diabetes and cancer.
But there area a lot of calculations to consider.
Four years ago, the cost of caring for an AIDS patient in the U.S. was estimated at about $25,000 a year -- or $600,000 over the average life span of 24 years. That's up significantly from estimates in the 1990s, when there were fewer drugs and shorter life spans.
But according to the Centers for Disease Control and Prevention, the HIV epidemic is still growing among gay and bisexual men. Gay and bisexual men are 44 times more likely to get HIV than other men, CDC statistics show. They now account for more than half of roughly 60,000 new HIV infections that occur nationwide each year.
So targeting the prevention pill might be one way to make it cost effective.
Cost-effectiveness analyses should help determine whether insurers and government programs should help pay, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Another crucial element to be considered is compliance. If people don't take the drug, it's not going to work.
Among men who took their pills at least half the time in the study, the risk of infection fell by 50 percent. For those who took pills every day about 90 percent of the time, the risk fell 73 percent the study says.
NPR's Richard Knox will have more on this story tonight on All Things Considered.
MARY LOUISE KELLY, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Mary Louise Kelly.
MELISSA BLOCK, host:
I'm Melissa Block.
And we begin this hour with a major advance in preventing the spread of the AIDS virus. Gay men who take an antiviral pill every day can sharply reduce their chances of getting HIV, even when they don't always practice safe sex.
That's according to a new study released this morning by the New England Journal of Medicine.
KELLY: It's the first time anyone has shown that a pill can prevent HIV infection in gay and bisexual men. Government officials plan to study the pill in heterosexual men and women, too, and in people who inject illicit drugs. But even before those results are known, today's findings are sure to set off a debate about how the pill is used and who will pay for it.
NPR's Richard Knox reports.
RICHARD KNOX: Researchers gave a drug called Truvada to gay men who were at high risk of getting HIV. The drug is widely used to treat people who are already infected. Among 2,500 study participants in a half dozen countries, half got Truvada, half got a placebo. Among men who took the pills at least 90 percent of the time, Truvada cut their risk of getting HIV by 73 percent.
Dr. Robert Grant of the University of California at San Francisco led the study.
Dr. ROBERT GRANT (Professor of Medicine, University of California, San Francisco): This is an important advance because it can help protect gay and bisexual men from acquiring HIV, and it's particularly effective in those who use it consistently.
KNOX: And even in those who didn't use the drug consistently, it reduced HIV infections by 44 percent. Dr. Anthony Fauci of the National Institutes of Health says the government decided to try the new approach because preaching safer sex just isn't stopping the spread of HIV.
Every year, nearly 57,000 Americans get infected and more than half are gay and bisexual men.
Dr. ANTHONY FAUCI (Director, National Institute of Allergy and Infectious Diseases): We have had frustrations all along in getting people to use condoms, getting people to reduce their number of sexual partners. We would have liked that those things worked.
KNOX: So now, AIDS experts have something new.
Mr. MITCHELL WARREN (Executive Director, AIDS Vaccine Advocacy Coalition): What we have is a biologic success with a huge behavioral challenge.
KNOX: That's Mitchell Warren of AVAC, a group that advocates for better HIV prevention. One big challenge is getting people to take a daily pill when they're not feeling sick. So, researchers want to find out if the drug will work if you only take it before and after sex.
One fear is that a prevention pill will lull people into thinking they don't have to use condoms, or they'll be less cautious about the number of sex partners they have.
Mr. WARREN: It is safe to say that there will be some people who say, somehow, this pill gives license for certain behaviors that dare not speak their name. I don't think that's the case at all. There's nothing yet to indicate that this pill is radically unleashing people.
KNOX: In fact, the study found men increase their use of condoms and decrease their number of sex partners, partly because everyone got safe sex counseling. But the biggest obstacle to the prevention pill is sure to be its cost: more than $35 a pill, or around $13,000 a year. In the developing world, it can cost as little as 40 cents a pill. Advocates hope the price can come down if the demand is high enough, and that insurance companies will pay for it just as they pay for pills to prevent heart disease.
Scott David Owens(ph) is a 52-year-old gay man in Boston who's HIV negative. He participated in the new study. When a nurse called him this morning with the news of the study, he says he got pretty emotional.
Mr. SCOTT DAVID OWEN: I just think of the people that I've lost and realized how more important this is, that people have this drug available to them because it's going to save a lot of lives all over the world.
KNOX: Owens says he tries to be careful. But for him and for many others, there's a need for a better way to prevent HIV infection.
Mr. OWEN: Most people, I hope, practice safer sex. But even if you do use condoms, that it would just be a, you know, more support to keep you free from the virus.
KNOX: Scott Owens says he might be willing to pay $35 a pill even if he had to cut back on other things. But he says he'd have to give it a lot of thought.
KNOX: Richard Knox, NPR News, Boston. Transcript provided by NPR, Copyright NPR.