Truvada Study Yields Surprising STI Finding

Truvada is the only FDA-approved drug to prevent HIV. (Photo: Justin Sullivan/Getty Images)

By Maggie Callahan

Experts are both optimistic and troubled following Kaiser Permanente’s recent successful study surrounding the HIV prevention drug Truvada.

During the 32-month study, Truvada was found to be 100 percent effective in preventing diagnoses of HIV among 657 people, all but four of whom were men who had sex with men.

Cases of other sexually transmitted infections, however, were a different story: 187 of the participants were diagnosed with 344 cases of other sexually transmitted infections, including syphilis, gonorrhea, and chlamydia.

“Without a control group, we don’t know whether the high rates of STIs in our study were higher than what we would have seen without (Truvada),” said Julia L. Marcus, PhD, MPH, a co-author of the study and principal investigator of the grant that funded the work. “Some patients reported decreased condom use, but there were reported decreases in condom use in the community prior to the introduction of (Truvada).”

A combination of two antiretroviral drugs, Truvada has been used in HIV treatment for more than a decade. The Food and Drug Administration approved its use as a preventive measure, or PrEP (for pre-exposure prophylaxis), in 2012. Truvada is the only drug FDA-approved to prevent HIV, but other HIV medications are being studied for pre-exposure uses.

While the Truvada study is encouraging about a future free of HIV, it highlights the need for more safe sex education regarding other STIs. Justin Lehmiller, a social psychologist at Ball State University and author of the blog Sex and Psychology, said he becomes concerned when people seem nonchalant about sexually transmitted diseases other than HIV.

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“We’re in an era when infections are becoming more resistant to antibiotics and other treatments,” he said. “For example, gonorrhea. It won’t be long before we don’t have any defenses left for this infection. The way I see it is that Truvada is a backup in the case that condom fails.”

According to the Centers for Disease Control and Prevention, the number of new cases of HIV every year is relatively stable, at about 50,000 new infections. The rates of other STDs, such as gonorrhea, are on the rise. Syphilis rates are also creeping up, especially for gay and bisexual men. With these numbers in mind, the CDC stresses the importance of ongoing condom use.

First author of the Kaiser study, Jonathan Volk, MD, MPH, echoes Lehmiller’s sentiment, warning that no method is foolproof and that Truvada “is one more tool, one more option to prevent the transmission of HIV.”

While most Truvada users are men who have sex with men, the study underscored the importance of the drug for other high-risk individuals, including people with an HIV-positive partner and people who engage in sexual activity with sex workers, IV drug users, or those incarcerated, among others.

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Bobby Dempsey, 28, started taking Truvada three months ago.

“It seemed silly not to, as a single gay guy,” Dempsey, who lives in Columbus, Ohio, said. “I honestly look at it exactly like birth control. I try to be as safe as possible, but slip-ups will always happen. I want to do everything I can to keep myself safe.”

Robert Weiss, LCSW, CSAT-S, the senior vice president of clinical development for Elements Behavioral Health, said it’s difficult to make good decisions in the heat of the moment, so Truvada is an ideal backup in those spontaneous cases or when a condom breaks.

“Nobody can predict how they are going to act when they are in an extremely passionate, distracting situation,” said Weiss. “What a great opportunity to ensure your health.”

Jermaine Holliway, a 34-year-old single man living in Manhattan, said he has plans to ask at an upcoming doctor’s appointment about PrEP as a potential tool in his safe-sex arsenal

“I’m not going in with the misconception that I can’t catch anything else,” he said. “It’s just one more thing I want to be precautious with. There are times when there are lapses in judgment – I’m not going to lie. It’s behavior that happens anywhere, this would just be with less of a guilty conscious.“

Even if PrEP were to decrease condom use, sex experts are confident that PrEP will not make users more promiscuous. This has been a common concern since Truvada was approved for prevention, with the label “Truvada Whore” directed at users.

“I don’t think it’s going to encourage people to have casual sex who are not already doing it,” Lehmiller said. “People are not going to have casual sex based on whether or not they are going to get HIV.”

Wendy Walsh, a psychologist known as “America’s Relationship Expert,” agrees, giving the example that sex education and condom distribution in schools does not lead to more sex.

“It’s not going to put someone who has another way of thinking over the edge,” Walsh said. Each person has their own attachment style, like preferring serial or engaging in casual hookups, and this isn’t likely to change because of lessened HIV fear, she said.

Regardless, it will be awhile before Truvada is widely accessible. Although many large insurers do cover costs of the drug, it is incredibly expensive for the uninsured – over $1,000 a month. Gilead, the maker of the drug, does offer a co-pay program.

Others have reported having trouble finding a prescribing doctor. Dempsey said he sidestepped this problem by seeing an infectious disease doctor who was willing to give him a prescription.

Volk said that anyone having trouble finding a prescribing doctor should turn to friends or other members of the community for referrals.

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