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A "Morning Before" Pill to Prevent HIV Infection

In the next decade, people may begin taking HIV medications to prevent contracting the AIDS virus, much the same way people take malaria pills. A somewhat odd study of macaques done by a group of researchers with the CDC demonstrated that two anti-retroviral medications, Emtricitabine and Tenofovir, were relatively successful at stopping HIV-like infections in the monkeys. This is great news if it turns out to work in humans. The weird part was how the researchers chose to expose the macaques to the disease. Let's say they really went for realism.

Each macaque was exposed "rectally" to the virus, repeatedly over a series of weeks. A release about the study said:

To simulate a common route of HIV transmission in humans, the researchers exposed the macaques to low weekly doses of [HIV-esque virus] SHIV that were given rectally. Five groups of macaques were all exposed to the virus in the same way, but they were given different dosages and combinations of antiretroviral drugs. Three groups received drugs daily: the first was only injected with one anti-HIV drug, emtricitabine (FTC); the second group received a daily dose of this drug by mouth in combination with an oral form of another anti-HIV drug called tenofovir; the third was injected with FTC and a high dose of tenofovir every day. A fourth group was also injected with FTC and a high dose of tenofovir, but macaques in this group were only treated shortly before and after the weekly exposures to HIV. For comparison a fifth group of macaques received no anti-HIV drugs.

The results showed that macaques from any of the four groups that received drugs were less likely to become infected than those in the fifth (control) group. All of the macaques receiving the combination of both FTC and the high dosage of tenofovir were protected from infection — whether they were from the group that received these drugs daily, or only around the time of exposure to infection. The results suggest that higher doses and combinations of drugs worked better than single or low doses, and also that PrEP may not need to be taken every day to be effective.
I understand the need to recreate the circumstances surrounding HIV transmission in humans. But isn't it just as likely that a human might get HIV from a dirty needle or transfusion? Plus, anal sex isn't the only way HIV is transmitted — in Africa, where AIDS is a far more devastating problem than in the West, it's transmitted from penis-in-vagina sex.

I guess the researchers in this study really wanted to focus on preventing the spread of HIV via anal sex. Fair enough. People who think they might be at risk for contracting HIV through sex could go on a course of Emtricitabine or Tenofovir and worry less about wrapping themselves in layers of latex. I can't wait for the day when clinics in San Francisco have giant candy dishes full of HIV drugs next to the shiny trays of condoms. Image by rselph.

Prevention of Rectal SHIV Transmission in Macaques by Daily or Intermittent Prophylaxis with Emtricitabine and Tenofovir [PLoS Medicine]

7:30 AM on Tue Feb 5 2008
By Annalee Newitz
1,712 views
30 comments

Comments

  • my guess is that it's easier to shove something up a monkey's butt than to replicate vaginal sex.

  • Image of braak braak at 07:48 AM on 02/05/08 *

    @wilmawonker: Really? Don't monkeys basically have sex with each other all the time?

  • It is actually surprising that they chose the rectal route for infection. Almost all other studies testing treatments to prevent HIV infection are in fact vaginal. In Western countries, the rectal route of infection is much more common than vaginal. And, heterosexuals do engage in anal sex as well as homosexuals. Risk of HIV infection from a transfusion in 2008 is almost nonexistent in Western countries.

  • Image of braak braak at 07:58 AM on 02/05/08 *

    You know, I understand that we have to test horrible things on animals in order to get cures and advance medicine and all that.

    But does anyone else balk at the idea of repeatedly ass-raping monkeys in the name of science?

  • "penis-in-vagina sex"
    I love the advanced scientific terminology...

  • @braak: probably, but that's not how they give them the disease, they probably shove a 'pill' up there. or whatever you call pills you shove up into someone's butt. i'd call them enema pills, but don't enemas clean you out?

  • @braak:
    I just like to picture the dinner conversations when Mrs./Mr.Scientist comes home.
    "So, dear, how was work today?"

  • If people saw my buffalo hump side effect from my retro-viral's they would surely think twice about taking even one. Use the condom's for peat's sake.

  • @Katana_Mind:
    "Just another day of ass-raping monkeys. How was your day dear?"

    Yeah, I find it disturbing not so much the testing on animals, since the SIV is not detrimental to the monkeys, but to ass rape over and over. Do they eventually start to like it, as if they're a prison bitch?

  • The rectal route for AIDS transmission is NOT for the amusement of the researchers or the vilification of homosexuals versus AIDS patients who get the disease from needle injections.

    The term "auto-immune deficiency" should also have implications to an intelligent (and honest) researcher that the body has lost its ability to produce anti-bodies. The most likely "cause" is not just a reaction to a virus but a reaction to its own fecal matter (or epithelial tissue) that has been allowed into the blood stream by disruption of the anal membrane due to "anal intercourse" or non-sterile needle injections.

    Unlike the vagina, the anus is evolutionarily NOT designed for items to be inserted into it, but rather for material to be excreted from it. Just because you can stick something up an anus does not mean you should. My dog does not defecate where she eats. The fact that pigs DO defecate where they eat is likely an empirical reason why some religions ban the eating of pork.

    It is also the primary reason for the increase in female cases of AIDS. In some cultures (such as "African cultures") anal intercourse is the primary means of "birth control."

    There IS an AIDS virus. But the reason why it has not been directly correlated to the spread of AIDS is that it does not cause the disease so much as it keep the immune system shut down after the immune system is initially shut down in response to its own (fecal) material and tissues being abnormally injected into the circulatory system. When the body recognizes its own tissue, the "normal" response is to shut down the immune system until the self-referential material is flushed from the circulatory system. Once the self-referential material is gone, the immune system recovers. What the AIDS virus does is to block that recovery.

    As a former microbiologist, if I had 30 test animals, a supply of the "AIDS virus" and a laboratory, I could "prove" my theory in 5 weeks.

    This is NOT a criticism of homosexuals as people or their love of other human beings. Rather it is a suggestion and recognition of the biological advisability of NOT having anal intercourse.

  • Dear Straight People Who Never Read Dan Savage (Much Less Biology&Sexuality Literature): I'm pretty sure there are power-bottom monkey males out there. One doesn't have to be a bonobo to like it ..um, every which way but loose.

    OH YEAH GIVE IT TO ME... NOW WITH THE BANANA, YEAH THAT'S RIGHT...

    /buttsex funny haha.
    //prison rape also very funny
    ///aaaand immunodeficiency for the trifecta

  • for a moment i mistook macaques for macaws. you think putting a virus up a monkey's butt is hard...

  • I absolutely support monkey anal violation if it saves human lives. Infecting them with HIV is far worse, and still utterly worth it.

  • @hold2file: Hysterical! I especially love how you chose to punctuate "African cultures" as if they are theoretical.

    Out of curiosity, why aren't you still a microbiologist?

    @geekgrrl: I thought the exact same thing at first!

  • Image of braak braak at 10:19 AM on 02/05/08 *

    @femto: Well, I'm not saying I'm necessarily opposed to it. I just feel weird about needing to figure out my stance on the ethical ramifications of ass-raping monkeys for science.

  • @hold2file:

    Yeah, most of that this person said.

    Also, anal sex is much more likely to induce tearing to the rectal epithelium than vaginal intercourse is to create wounds in the vagina. This is, in effect, rubbing HIV directly in to an open wound. Interestingly, using condoms/jellies with the common spermicide nonoxynol-9 will actually increase your risk of contracting HIV over ones without n-9 by about 50% This is due to the exact same effect; nonoxynol-9 is an irritant and will induce microscopic (and sometimes large) lesions through which the virus can pass.

    So be safe folks, use n-9 with people you KNOW to be STD free, but don't use it with people you can't be entirely sure about. Also, NEVER use lambskin condoms with somebody that may have an STD as studies have shown that they are ineffective as viral barriers.
    Keep it wrapped, keep it durty, keep yourself clean.
    Also, quit making excuses about "not having a condom around" or "it doesn't feel as good" or "i can't get off when i wear a condom" I've heard them all, I've used them all myself, and they're stupid no matter who's saying them. Get tested regularly, and be responsible.
    Routes of HIV infection aside, this seems like an absolutely stupid idea. All it will do is give people more excuses to not use a condom. We'll end up with more unwanted pregnancies, and more abortions that could have been prevented by birthcontrol/condoms/spermicide/IUDs/fertilityplanning/diaphragms/ligations/vasectomies/education/etc.
    I'm all for reducing the spread of HIV, but if all it will do is make people more likely to engage in 50% risk sex as opposed to 0.1% risk sex... seems like a net loss for the good guys.

  • @braak:

    Alright then, instead, we could round up every HIV positive human on the planet and put them in camps to isolate them from the general population.

  • @wingbatwu:
    1) unfeasable - there's pretty much no way to actually pull it off with any degree of efficacy.
    2) impossible - You'd never get that many governments to agree on anything. ever. Who would fund it, who would take credit for it, who would host the camps, who would care for the dying...
    3) illegal - I can't say it's true for every country, but they'd never be able to pass the laws necessary to make it happen in the USA. It's too invasive. You'd have to test everybody. The government would have to, by force, take a sample of your fluids, quite likely against your will (violates 4th amendment). They would then have to have to use that sample to find you in violation of the law, and they'd have to remove the right to a fair trial to make it happen (violates 5th amendment). And then they'd have to hold you for the rest of your life just for being sick (violates 8th amendment.) Also, they'd have to get the guns out of the hands of all the people defending their own rights (violate 2nd amendment).

    They might make it a voluntary thing, where you go check in... but they couldn't keep you if you wanted to leave... and they'd have to give you an very expensive standard of living to convince you to stay. And then people would literally be dying to get in... bad news all around.

  • The animal-rights ninnies are going to especially like this.

    I'm perfectly happy to kill and eat animals, so this seems sort of ordinary to me.

    @Braak: The word you're looking for is 'suppository'.

    -Kle.

  • Image of braak braak at 11:23 AM on 02/05/08 *

    @wingbatwu: Aside from that guy over there's excellent explication of the practicality of such an event, I'm already sure where I stand on those ethical ramifications.

  • @Klebert:

    animal rights ninnies?!?

    I guess i am one of those ninnies.
    I am vegetarian because i dont think animals should be murdered just for food. The conditions in large animal factory farms are abysmal and probably 1000% times worse than human prison, where people are kept because they actually deserve it... as opposed to animal prisons where innocent living creatures are kept, pumped full of medicines and hormones, and killed for the benefit of an environmentally unfriendly meat based diet.

    I am also opposed to nearly all forms of animal testing. when it is only a luxury... (i.e testing makeup, food, chemicals, etc).
    But I am not opposed to animal testing IF it can actually benefit medical science.

    the real ninnies are the ones that have no regard for innocent animal life.



  • Cuba does it. [www.aegis.com]

  • @craigdawson:

    I don't know if it makes you feel better, but I wholeheartedly support your having whatever opinion you choose.

    Just don't expect my political support.
    -Kle.


  • It occurs to me that there's a perfectly straightforward reason for this methodology that I don't think anybody's mentioned.

    They're trying to find a new method for preventing the spread of the disease through sexual contact, so they're going to have to use some sort of simulated sexual activity for the infection vector. If they choose to simulate vaginal sex, they can only use female macaques as test subjects, but if they simulate anal sex, they can use both genders, increasing the number of potential test subjects. They're also going to want the vector to be the same for all subjects, to reduce variables.

    On top of that, the female macaques are probably more valuable, since you need more of them for a good breeding program.

    I don't know if this is their reasoning or not, but it seems plausible.
    -Kle.


  • @wingbatwu:

    You said all the infected people in the WORLD, not one communist country that has a well documented history of distorting the facts about how well things are going. If Cuba is really taking such great care of the citizenry, why are the same people that Zombie-Castro says will stand up and defend the country to the last man doing whatever they can to find objects that will float them to the coast of Florida?

    And I never said it wouldn't work in some cases, but I'm absolutely certain it wouldn't work out well in any "free" nation.

  • I wasn't aware that this type of thing was "news"... the ARV issue, and not the vivisection issue.

    Healthcare workers have been seeking to prevent HIV infection with ARVs for some time now. I have a friend who's an EMT who was telling me about this a while ago. Basically, if one of his coworkers gets accidentally exposed to HIV from a needle or bloody patient, they flood their system with ARV drugs and some large chunk don't become HIV positive. (He had a scare a few months ago when he got blood in his eye, but thankfully, the patient's bloodwork came back negative.) I forget the details so I apologize for the layman's re-telling, but there are already consenting human beings who have been their own test monkeys for ARVs being used in a "morning after" type of way. I wonder if those healthcare workers are being studied?

    Here's more on google for the curious: [www.google.com]

  • @Klebert:

    and i dont have a problem with people eating animal meat.....
    As long as it is done in an environmentally responsible manner. As in: hunting is fine and small family size farms are fine - if they raise the animals in at least a somewhat more humane method... but huge factory farms are not fine, as they are more environmentally destructive - and that affects EVERYONE. Not to mention they take the most of government subsidies.

    With all the money the government gives out in meat producing subsidies... no wonder we have a wholesale slaughter of animals in this country unlike any other. And as long as our government dishes out that money, it promotes environmental destruction.

    Stop giving out that subsidy money, and meat will be more expensive... then less people will eat meat (and eat much more healthier foods), and there will be much less destruction of the environment.

    I would never agree to dictate what people can eat... but huge animal farms have to go...
    As a political position, even the most red blooded conservative American should agree with that. (as long as they care to have a habitable planet for their children's future).



  • I know what I said. I merely posted the link to an article about Cuba's method as an example to contradict the notion of impossibility.

    Besides, my original comment was a sarcastic retort. If you're not willing to test animals for medical purposes, what are your other options besides testing on humans?

    To take the problem even further, how far do you think a "free" nation would go during a truly quick and devastating epidemic? You think infected people would remain free?

  • @craigdawson:

    Now that this thread seems to have died, I don't feel guilty about continuing to derail it.

    I agree with you about farming, to some extent. It's definitely bad for the environment, largely due to the whole monoculture thing. Non domestic plants and animals have a much easier time coexisting with residential, commercial, and industrial land use than with agriculture. Heck, they do better with some forms of resource-extraction.

    The family farm argument doesn't really hold though - they're so much less efficient than agribusiness, that you wind up with vastly more land under cultivation, and thus more environmental damage instead of less.

    As for how the animals are treated... I can't really grasp why I would care. As long as they taste good and don't cause immediate pain or suffering to me when I eat them I don't much care what horrible things the farmers did to them. I like veal and foie gras just fine, for example - that's a lot worse than what happens to your average pig or cow. To me, worrying about the treatment of farm animals is sort of like worrying about the treatment of the coal that provides my electricity. I'm going to kill them (by proxy) and eat them anyway, so why should I pretend to be their friend?

    As for the health argument; even if your diet is actually more healthy, I tend to think health is a sucker bet. I'd rather have the known pleasure of eating something delicious now, than the potential 'pleasure' of living a few extra years at the end of my life in a failing body after having watched my friends die...

    -Kle.

  • @Merlinhoot: Oooh. Be as well as you can for as long as you can, dude.

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