This CNN story on two new studies of antiretroviral drugs for HIV prevention could have been improved. The cost of these drugs, whether in Africa or the United States, is a major issue that affects their viability as a prevention tool — a fact which the story didn’t touch on. And while the story suggests that the studies only involved medication, both included other interventions. According to a University of Washington press release, “All study participants received a comprehensive package of HIV prevention services, which included intensive safer sex counseling (both individually and as a couple), HIV testing, free condoms, testing and treatment for sexually transmitted infections, and monitoring and care for HIV infection.” These additional interventions are not routinely available and may have contributed to the studies results; an important consideration when considering an implementation strategy.
Stopping the spread of AIDS, especially in developing countries, has proven to be a very large challenge. The development of a preventive vaccine has not been as clear cut as originally assumed so alternative strategies are clearly needed. Two new studies strongly suggest that preventive strategies in the partners of AIDS infected individuals may be an effective strategy. While many questions remain, especially on how to operationalize this strategy, these two studies provide a basis for additional work
Although these drugs are available cheaply in developing countries (less than $1 per pill according to some estimates), even these modest costs can put them out of reach in the poorest countries where they are most needed. In the United States, the cost of daily treatment with Truvada (one of the medications studied which contains a combination of emtricitabine and tenofovir) can add up to some $13,000 annually. The story should have referenced cost as one of the obstacles to any large-scale new prevention effort
Readers should have been given a bit more information on actual number of infections seen in the study groups. The story states that infection risk for drug-treated individuals was 63% to 73% lower relative to individuals who received the placebo. However, the story never provides the absolute risk data that are essential to determining the true magnitude of the benefit. Elsewhere, the story states that infection rates were decreased by 78% in those “who actually got the drugs.” This is a confusing statement. The story should have explained that this was an analysis of outcomes based on participants’ adherence to the medication regimen; those who took the drug more regularly were more likely to see a benefit.
Given that the primary source was a press statement (the results haven’t been published yet), the story provided about as much information about potential harms as could be expected. In one of the studies, the story notes that the safety monitors saw no evidence of safety concerns. The story also notes that subjects taking the active drug in the the other study reported nausea, vomiting and dizziness.
While it is clear that the studies being covered were large, placebo-controlled trials, the story didn’t provide sufficient discussion of the limitations of this research. As the competing AP story pointed out, all participants in both studies received services that might not be available to individuals outside of a research setting, including free condoms and behavioral counseling to reduce infection risk. These services may have contributed to the low overall infection rate seen in the study. In addition, the story should have pointed out that because these study results were released in press statements ahead of a major AIDS conference, they haven’t yet been subjected to peer review by outside experts.
There was no disease-mongering in this story.
At least one independent source is quoted, and there don’t appear to be any conflicts of interest that should have been pointed out to readers.
The story mentions several other approaches that are effective for preventing HIV transmission, including microbicides, vaginal gels, clean needles, medical male circumcision, early treatment, counseling, testing, condoms and suppressive therapy for pregnant women.
Unlike the competing AP story, this story didn’t make it clear that there will be issues in getting this strategy implemented in Africa and in the US.
The story mentions earlier research showing that Truvada was effective for preventing HIV infections in men who have sex with other men. However, it did not reference the results of a large study showing that Truvada failed to prevent HIV infections in heterosexual African women — findings that remain somewhat of a mystery. The story could have done better here, but since it does not give readers the impression that these are completely novel or unexpected results, we’ll call it satisfactory.
The story does not appear to take its content directly from news releases put out by the University of Washington or the CDC, and it quotes a researcher who was not directly involved with either study, so we can be sure the story meets our standard here.