Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

14 June 2012

HIV Treatment as Prevention Biologically Plausible Using Ritonavir-Boosted Darunavir (Prezista) and Etravirine (Intelence)

via, by Michael Carter

A pharmacokinetic study suggests that ritonavir-boosted darunavir (Prezista) and etravirine (Intelence) achieve high concentrations in semen and rectal tissue, and could therefore help avert HIV transmission and infection, especially in gay men. Concentrations of these antiretrovirals were monitored over an eight-day period in HIV-negative volunteers. The study is published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

The US investigators believe their findings “provide pharmacologic plausibility for the use of darunavir plus ritonavir and etravirine in secondary HIV prevention, in both infected and uninfected individuals”.

Antiretroviral therapy has a central role in combination HIV prevention efforts. Treatment that suppresses viral load has been shown to reduce the risk of transmission in heterosexual couples by 96%. Anti-HIV drugs can also reduce the risk of infection with HIV when used a pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). Incidence of HIV remains high in gay men and they are therefore a priority for the use of HIV treatment as prevention.

It is currently unknown if specific combinations of antiretroviral drugs are more effective at preventing infection with HIV or onward transmission of the virus. “Defining the antiretroviral exposures in biological compartments that are vulnerable to acquisition and are sources of infection, such as rectal tissue and semen, could assist in selecting regimens for HIV prevention,” explain the authors.

They therefore designed a pharmacokinetic study lasting eight days involving twelve healthy HIV-negative men. Concentrations of darunavir/ritonavir and etravirine in blood, semen and rectal tissue were monitored intensively on day one and again on days seven/eight.

The participants had a median age of 27 years and were racially diverse. All tolerated the medications well.

After the first dose, all three drugs were detected in blood, semen and rectal tissue.

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