FDA panel approves FTC-TDF for HIV prevention

Last night, the U.S. Food and Drug Administration’s (FDA) Antiviral Drugs Advisory Committee recommended that emtricitabine/tenofovir disoproxil fumarate (FTC-TDF, marketed by Gilead Pharmaceuticals as Truvada) be indicated for use in preventing HIV, in what is known as pre-exposure prophylaxis (PrEP). The advisory committee’s recommendations will now be considered by the FDA, which is expected to issue a final decision on the matter by June 15, 2012.  The FDA usually accepts the advice of its advisory panels.

Kenneth H. Mayer, MD, Medical Research Director and Co-Chair of The Fenway Institute (Photo credit: Marilyn Humphries)

Fenway Health issued a statement commending the FDA panel’s decsion and Dr. Kenneth H. Mayer, Fenway’s Medical Research Director and Co-Chair of The Fenway Institute, was quoted in a Reuters story that was picked up by a number of major news outlets.

“Today is an exiciting day for HIV prevention. Although FTC-TDF for PrEP is not a panacea, this approach can prevent many new infections and could dramatically impact HIV transmission worldwide,” said Dr. Mayer.  “We at Fenway Health are gratified to have been involved with this field of research for several decades and are delighted to have helped to demonstrate the utility of this approach for prevention.”

You can read the full Fenway Health statement here

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FDA to review PrEP application today

Today, the U.S. Food and Drug Administration (FDA) is reviewing a supplemental new drug application for emtricitabine/tenofovir disoproxil fumarate (FTC-TDF) to reduce the risk of acquiring HIV in men and women by pre-exposure prophylaxis (PrEP), offered as part of a comprehensive HIV-prevention package including risk reduction counseling.

FTC-TDF pills

FTC-TDF is an anti-HIV medication being reviewed by the FDA for use in preventing HIV infection.

PrEP has the potential to be a game-changer in the effort to curb HIV infection worldwide.  Fenway Health called on the FDA to approve PrEP use in at-risk populations in written comments filed on April 26.

“We believe that if the FDA looks closely at the science, it will see the merit of allowing PrEP to be added to our tool kit to prevent HIV infections,” said Kenneth Mayer, M.D., Medical Research Director and Co-Chair of The Fenway Institute at Fenway Health and a leading researcher in the field of biomedical HIV prevention. “We must deploy new tools to prevent new infections, which are affecting 50,000 Americans each year and more than 2 million people worldwide, most in Africa,” Mayer continued. “PrEP combined with sustained behavioral interventions and medical care to maintain adherence could help us finally begin to turn the tide with this virus.”

Earlier this year, The Fenway Institute issued a Policy Focus summarizing the state of PrEP and microbicides research as of January 2012, looking at willingness to use PrEP among various populations, addressing concerns about PrEP that could present obstacles to implementation, offering strategies for effective implementation, and examining policy issues related to cost and how to make PrEP accessible to those most vulnerable to HIV.

“PrEP has the potential to dramatically reduce HIV incidence among gay men, heterosexual women and men, and other populations,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute and author of the report. “We look forward to action by the U.S. Food and Drug Administration and the World Health Organization this year to make PrEP available to those most vulnerable to HIV. PrEP could prove an invaluable new tool in the fight against HIV.”

Cahill has also authored a couple of op-ed pieces arguing for the approval of PrEP as an HIV prevention tool, first on March 26 on The Boston Globe’s Podium online opinion blog and then yesterday, May 9, on The Huffington Post.

We’ll be closely watching today’s hearing and will keep you posted about the FDA’s decision. 

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Policy Focus: PrEP Could Be A “Game Changer” in Fight Against HIV

Analysis examines biomedical prevention technology to be reviewed by U.S. Food and Drug Administration by June 15, 2012

Pre-exposure chemoprophylaxis (PrEP)—taking antiretroviral medications to prevent HIV transmission—could be a “game changer” for HIV prevention. PrEP has demonstrated partial efficacy with men who have sex with men (MSM), transgender women, and heterosexuals in several recent studies. Recent modeling of PrEP implementation coupled with scaled up treatment predicts that PrEP could significantly reduce HIV incidence and prevalence. And if PrEP is accompanied by sustained care, behavioral interventions, and safety monitoring, PrEP need not lead to increased sexual risk behavior or drug resistance.

The latest Policy Focus from The Fenway Insitute summarizes the state of PrEP and microbicides research as of January 2012, looks at willingness to use PrEP among various populations, addresses concerns about PrEP that could present obstacles to implementation, offers strategies for effective implementation, and examines policy issues related to cost and how to make PrEP accessible to those most vulnerable to HIV.

The Fenway Institute’s analysis found that the most effective prevention interventions will be those that combine behavioral interventions, structural interventions, and emerging biomedical technologies, such as PrEP and microbicides. The analysis concludes with recommendations for implementation of PrEP, including:

  • If the U.S. Food and Drug Administration (FDA), which is considering approving FTC-TDF for use as PrEP, feels that research on PrEP’s efficacy among heterosexuals is inconclusive, it should consider approving PrEP for MSM now separately and consider heterosexuals, IDUs and other populations in the near future as the science advances;
  • The World Health Organization (WHO) should issue guidance on PrEP that takes into account the promising results of the iPrEx study, Partners PrEP, and the Botswana CDC study;
  • Following the release of the Bangkok injection drug user (IDU) trial results, if appropriate the U.S. Centers for Disease Control and Prevention, the U.S. Public Health Service, and the WHO should issue guidance for PrEP with IDUs.;
  • States should provide access to PrEP as a critical prevention service and prescription medication under the Essential Health Benefits provision of the Affordable Care Act;
  • State Medicaid programs should also cover PrEP as a cost-saving measure that will improve public health and ultimately save money in health care costs;
  • Provision of PrEP to MSM and transgender women should occur in a broader context of ensuring clinically competent health care to gay, lesbian, bisexual and transgender people.
You can read or download the full PDF document below or on The Fenway Institute’s website.

You can also read past Policy Focuses on asking about sexual orientation and gender identity in clinical settings

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