For some, it is an easy choice. If your partner has HIV and you don’t, this pill should be considered. Also, the pill has been quickly embraced by the gay porn industry, and for some injection drug users. Yet it certainly isn’t appropriate for the entire sexually active population to take this pill, as it is cost prohibitive, and no medicine is without side effects. Truvada comes with a black box warning for those with unknown HIV status, and small risk of renal impairment. As for that unknown HIV status, the CDC states that of the 1.1 million people living in the US with HIV, 1 in 8 are unaware that they are even infected.http://www.cdc.gov/hiv/statistics/basics/ataglance.html. So from this we can conclude there is a large number of people who don’t even realize they are at risk for getting HIV. It would be difficult to identify people who might benefit from Truvada if they aren’t even getting tested.
For others, there is a matter of adherence. Medication Adherence by definition is the patient’s ability to do what the provider’s recommends as far as respect to timing, dosage, and frequency of medication-taking during the prescribed length of time. As you can see, this is a complicated set of instructions, which can be thrown off by any number of life events. Fortunately dosing with Truvada is simple, once daily, with or without food. Adherence is a tough pill to swallow, so to speak. According to the CDC, up to 1/3 of patients never fill prescriptions in the first place. If a person were to go on Truvada, we could expect their resolve would lessen after about 6 months; 25% to 50% discontinue therapy by one year.http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf
And what of cost? HIV does not discriminate, it infects folks of any socioeconomic class, and prevention drugs of this type are not often covered by health insurance, though Medicaid and some insurance companies are starting to foot the bill; Gilead offers a reimbursement program if your insurance company is one that does not cover the $1,000 a month cost.
Truvada, for those who know they are at risk and will remain adherent and experience no side effects, is a wonderful advance. But there still needs to be an eye on overall STD prevention, HIV testing, and vaccine development.