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Drug Therapy For Prevention? J. Jeff McConnell, Sociologist GLADSTONE INSTITUTE OF VIROLOGY AND IMMUNOLOGY UNIVERSITY OF CALIFORNIA, SAN FRANCISCO September 30, 2008
An excellent resource available at http://www.avac.org/prep08.pdf
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adults and Children Estimated to be Living with HIV, 2007
HSV-2 Suppressive therapy Management of genital infections (STIs) Cervical Barriers Male circumcision Chemoprophylaxis MTCTP PEP PrEP Vaccines Condoms HIV PREVENTION Microbicides Behavioral Counseling and Testing
Research Victories/ Prevention Disappointments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Male circumcision (Not known to be helpful for men who have sex with men) Chemoprophylaxis MTCTP (PEP PrEP have unknown  efficacy) Condoms HIV PREVENTION Behavioral Counseling and Testing (Intensive not better than standard)
[object Object],[object Object],[object Object]
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why Chemoprophylaxis? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Promising Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Promising Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object],Post-exposure Prophylaxis (PEP ) ,[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Promising Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Post-exposure Prophylaxis (PEP ) ,[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Promising Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Post-exposure Prophylaxis (PEP ) ,[object Object],[object Object],[object Object],[object Object],Pre-exposure ART microbicides ,[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Post-exposure Prophylaxis (PEP ) Pre-exposure ART microbicides
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ART as Prophylaxis—A Promising Self-Initiated Prevention Alternative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Post-exposure Prophylaxis (PEP ) ,[object Object],[object Object],[object Object],[object Object],Pre-exposure ART microbicides ,[object Object],[object Object],[object Object],[object Object]
Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m
Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m HIV  infection
Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV Post-exposure  prophylaxis 28 d 3 m 6 m HIV  infection
Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV Pre -exposure  prophylaxis 28 d 3 m 6 m HIV  infection
Why Pre-exposure? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m HIV HIV Pre -exposure  prophylaxis
Which ART? Preclinical Evaluation of  Tenofovir (TDF) + Emtricitabine (FTC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tsai ‘95; Van Rompay ‘99 ‘00 ‘01 ‘04; Subbarao ’05; Heneine’06 ‘07 ‘08
PEP & PrEP Similarities and Differences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],2007
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The iPrEx Study:  Safety, Efficacy, Behavior, and Biology Sponsored by NIH/NIAID/DAIDS with co-funding by the Bill and Melinda Gates Foundation and drug donated by Gilead Sciences                  
 
The iPrEx Study:  Safety, Efficacy, Behavior, and Biology Gladstone Institute  of Virology and Immunology
[object Object],[object Object],[object Object],[object Object],PrEP & iPrEx ,[object Object],[object Object],[object Object],[object Object]
“ Let’s Communicate” From February 2004, the iPrEx study communicated with participants, activists, government, sponsors, physicians…
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The PrEP Research Portfolio http://www.avac.org/prep08.pdf
Current PrEP Portfolio
Acknowledgements ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Drug Therapy For Prevention?

  • 1. Drug Therapy For Prevention? J. Jeff McConnell, Sociologist GLADSTONE INSTITUTE OF VIROLOGY AND IMMUNOLOGY UNIVERSITY OF CALIFORNIA, SAN FRANCISCO September 30, 2008
  • 2. An excellent resource available at http://www.avac.org/prep08.pdf
  • 3.
  • 4. Adults and Children Estimated to be Living with HIV, 2007
  • 5. HSV-2 Suppressive therapy Management of genital infections (STIs) Cervical Barriers Male circumcision Chemoprophylaxis MTCTP PEP PrEP Vaccines Condoms HIV PREVENTION Microbicides Behavioral Counseling and Testing
  • 6.
  • 7. Male circumcision (Not known to be helpful for men who have sex with men) Chemoprophylaxis MTCTP (PEP PrEP have unknown efficacy) Condoms HIV PREVENTION Behavioral Counseling and Testing (Intensive not better than standard)
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18. Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m
  • 19. Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m HIV infection
  • 20. Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV Post-exposure prophylaxis 28 d 3 m 6 m HIV infection
  • 21. Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV Pre -exposure prophylaxis 28 d 3 m 6 m HIV infection
  • 22.
  • 23. Pre vs. Post-exposure prophylaxis 0h 36h 72h HIV 28 d 3 m 6 m HIV HIV Pre -exposure prophylaxis
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29. The iPrEx Study: Safety, Efficacy, Behavior, and Biology Sponsored by NIH/NIAID/DAIDS with co-funding by the Bill and Melinda Gates Foundation and drug donated by Gilead Sciences                  
  • 30.  
  • 31. The iPrEx Study: Safety, Efficacy, Behavior, and Biology Gladstone Institute of Virology and Immunology
  • 32.
  • 33. “ Let’s Communicate” From February 2004, the iPrEx study communicated with participants, activists, government, sponsors, physicians…
  • 34.
  • 35. The PrEP Research Portfolio http://www.avac.org/prep08.pdf
  • 37.