AIDS pill as party drug?
“Taking a T.” That’s what HIV-negative gay men call the growing practice of downing the AIDS drug tenofovir and, with fingers crossed, hoping it protects them from the virus during unprotected sex.
It’s being sold in packets along with Viagra and Ecstasy in gay dance clubs -- and even prescribed by physicians, say doctors and AIDS prevention experts. The trend has alarmed public health officials. There is no proof that tenofovir protects against HIV transmission, they say. People who practice unsafe sex while taking the drug could still become infected or suffer side effects from it.
Recreational use of AIDS drugs also might increase overall resistance to the medications, HIV experts say. “This is a very worrisome development,” said Dr. David Hardy, an HIV doctor at Cedars-Sinai Medical Center in Los Angeles. He said the drug could lead to an even further erosion of condom use, which studies show has been falling among high-risk populations.
A survey released in July by the U.S. Centers for Disease Control and Prevention, conducted at gay pride events in four cities, found that 7% of uninfected men had taken an AIDS medication before engaging in risky behavior and that about a fifth had heard of someone who had.
Prevention experts stress that the number of men taking the drug in this manner remains small. So far, it appears to be most popular among young gay men who aren’t using condoms and people who frequent sex clubs and bath houses.
But health officials say the use is growing quickly. They worry that the practice could spread into other high-risk segments of the population, such as sex workers and IV drug users, and then into the general public. HIV experts, in the meantime, continue to promote condom use as the most effective means of preventing transmission.
“If we find out this works, even in some people, we would never recommend people stop using condoms or reduce their number of sexual partners,” said Jeff Klausner, STD prevention director for the San Francisco Department of Public Health. Nonetheless, there is some research that suggests taking the drug prophylactically can reduce the risk of transmission. Based on promising earlier research, the CDC is funding two clinical trials, begun last year in Atlanta and San Francisco, on whether tenofovir, a staple of the current HIV drug regimen, may act as a shield to infection -- much like how a birth control pill can help prevent pregnancy. Each trial is giving 200 high-risk men a daily dose of tenofovir and monitoring them for two years.
The drug already is widely used as part of a drug regimen given to people who may have been exposed to the virus. Health workers who are stuck by a needle, for instance, take a mix of medications, including tenofovir, for 30 days to reduce their chance of becoming infected.
Studies also have shown that the medication may help prevent infection in healthy monkeys.
Marc Conant, an HIV doctor in San Francisco, said he recently began prescribing tenofovir to two uninfected men after they told him they were very sexually active and would not use condoms. Though troubled by the fact that the drug hasn’t been proven effective for such a use and that his patients may be increasing their risky behavior while using it, he says using the drug is better than taking no precaution at all.
“What choice do I have? Forty-thousand people are still getting infected every year,” he said. “Everyone knows condoms work, but they’re not using them. All I am trying to do is reduce the risk that people harm themselves.”
Conant said he tests both patients every three months and that they remain negative.
Tenofovir works by blocking an enzyme the virus needs to replicate. Although other AIDS medications may also have protective effects, researchers believe that tenofovir is especially promising at reducing the risk of transmission because the drug has few side effects and remains in the body for up to two days.
Dan Uhler, a prevention counselor at a San Diego gay men’s health clinic, said the drug first appeared about a year ago in gay clubs and at circuit parties, festival-size dance parties known for sex and substance abuse. It is sometimes sold with other drugs such as Ecstasy and methamphetamines for around $100. People who use tenofovir believe it “helps justify the risks they are taking,” Uhler said.
The growing use of the drug comes as HIV prevention efforts appear to be losing effectiveness among gay and bisexual men. Nationally, new HIV infections remain at around 40,000 a year, but a recent report released by the CDC found that last year new infections among gay and bisexual men rose 8%. A separate CDC report, released in October, found that syphilis rates among these men has climbed 29% over the last four years, indicating a spike in risky sexual activity.
Steven Gibson, director of a gay men’s health clinic in San Francisco, said the city’s public health department should educate the community about the dangers of taking tenofovir in unapproved ways.
He has opposed trials of the drug, he said, because of the likelihood that men would pursue the regimen on their own.
Other prevention experts worry about the sources of the drug. They believe some men are buying it online, raising questions of drug quality; others are getting it from HIV-positive friends, suggesting that those who are sharing doses aren’t keeping up with their own treatment schedule. Some HIV-positive men are selling the drug to make extra money, Uhler said.
Albert Liu, director of HIV prevention and intervention studies at San Francisco’s Department of Public Health, said the department planned to survey gay men early next year to see how many of them are using the drug before having sex.
If the numbers are as high as the CDC survey found, he said the department could begin educational campaigns about the drug’s risks and widespread use.
“What we are trying to find out is if this is safe,” Liu said. “Our goal is to find out what the best course of action is.”