DST PrEP: It can work, but it is a good idea?

コ ン ド ー ムA small pilot study with HIV-positive men 30 who had sex with men has shown that consumption of antibiotics in the PrEP treatment probably has protected against syphilis. The research can be read in English on the link: http://journals.lww.com/stdjournal/Fulltext/2015/02000/Doxycycline_Prophylaxis_to_Reduce_Incident.9.aspx

Although further clinical testing was required to confirm that 100 mg of doxycycline currently provides protection, research has shown that in the middle of this group that has a high risk of contracting STDs, those who received the antibiotic were less prone to contract gonorrhea, chlamydia and especially syphilis.

The volunteers in the study, who were patients of LA LGBT Center (The world's largest support center in health, citizenship, culture, legal aid, education for lesbian, gay, bisexual and transgender people, based in Los Angeles - USA), had contracted syphilis at least twice a year since they had a positive HIV diagnosis. After being tested for the three STDs at registration as volunteers in the study, followed by tests over 12, 24, 36 and 48 weeks with about risk behavior questionnaires.

Half of the patients received doxycycline, and half of the participants obtained financial incentives not to contract STIs. Still, 15 cases of STIs (gonorrhea, chlamydia, syphilis or a combination of them) have been reported in those who did not take medicine, as opposed to six cases in those taking doxycycline. medicine bottleIn the group who did not take the drug there were seven cases of syphilis as opposed to two of the volunteers who received the antibiotic.

There were no reports of significant differences in the behavior of the two groups.

The group that received no medication was offered you $ 50, 75 $ and $ 100 dollars to stay without STDs in the corresponding 12,24 and 36 weeks. The subjects of the group were not supposed to users of drugs and alcohol, with the exception of crystal methamphetamine, it does not influence in the search results.

With the explosion of cases of syphilis among men who have sex with men, the idea of ​​PrEP for STDs sounds promising for many experts in HIV prevention and STDs. However, the use of doxycycline as PrEP raises concerns among some in the medical community and certainly brings controversy.

AIDS drugs
Medicines for AIDS - Mera illustration; There are patients who take more medication than what is shown in this image and on the other hand, there are seropositive taking more ..

"A 2009 research on a population of 4.376 infected with HIV, all men who have sex with men (categorized using the acronym MSM- by the international medical community), found that 43,6% of cases of syphilis were diagnosed in only 3,8 % of patients in this population, "the authors wrote. "Based on these data, it is reasonable to consider the presence of a core group, specific, of seropositive MSM that disproportionately contributes to the current syphilis epidemic and directs the population for interventions."

Many Questions Without Answers

Dr. Matthew Golden, Division of Infectious Diseases and Center for AIDS and STIs at the University of Washingtom, wrote an editorial that is attached to research. You can read the English text in the link http://journals.lww.com/stdjournal/Fulltext/2015/02000/Preexposure_Prophylaxis_to_Prevent_Bacterial.10.aspx.

Both are published in this month's academic journal Sexually Transmitted Diseases. Golden concluded that there are many unanswered questions so that we can endorse the use of antibiotics as part of PrEP treatment for STDs.

The very idea of ​​using antibiotics is not as much need today is almost a taboo among health care. Two years ago the director Tom Frieden, the CDC (Center for Disease Control and Prevention, US-based), made an alert to the overuse of antibiotics.

"The implications of this research are controversial," the authors wrote. "Providers of Health, in general, and perhaps infectious disease specialists, in particular, are not typically prone to treat patients with long-term antibiotics, then, for many of us, there is an almost reflexive objection to the idea of ​​combat STIs (infections sexually transmitted) in PrEP. etiological agent - plotHowever, doxycycline is usually administered for weeks to months for significant but not threatening, acnes and rosacea (skin diseases that cause uneven redness and inflammation), and for weeks and years to prevent malaria.

Recently discovered with the use of antiretroviral drugs in the treatment PrEP, the emergence of drug resistance against STDs types is possible. Read the article written by David Heitz on Healthline on mutations of HIV during PrEP by clicking here: http://www.healthline.com/health-news/its-possible-to-contract-drug-resistant-hiv-on-prep-020515.

"Well prepared" Search had High Accession

In a statement to imstilljosh.com (a social media portal for HIV), Dr Amesh Adalja said the research was "well-crafted as it focused on high-risk individuals and actually measured their compliance, not by self- but by levels of the drug in the blood. The positive results of the research were the result of their high compliance - something very difficult to achieve outside of a population in clinical trials as evidence of PrEP failures. "

Adajla, considered one of the top infectious disease experts in the United States, has raised concerns about "the danger of prescribing antimicrobials in a prophylactic fashion while we are in one of the biggest battles against antimicrobial resistance. Although doxycycline is an old antibiotic and concerns about resistance are not so great, they exist especially for MRSA (an abbreviation for Resistance of Syphilis to types of penicillins such as methicillin, which has been replaced by more stable penicillins) where the drug is routinely used.

dst-2 214x300Dr Philip Chan is an assistant professor at Brown University and an expert in HIV. He has been researching the HIV PrEP in Providence- Rhode Island (USA), and has been a fierce advocate for better prevention measures against sexually transmitted infections (STIs, in English).

He told the portal imstilljosh.com that doxycycline is generally safe, although it is a drug "cheap and poor quality". He said it costs about $ 4 dollars a month along with some health plans. Side effects do not go beyond a little sick in the stomach.

And while it is an effective treatment for syphilis, he is not sure that the Los Angeles pilot research ensures a clinical trial on a larger scale. He said it is first necessary to know more about how the disease is transmitted. WATCH: MINUTE VIDEO- News Noisy worth in less than 60 Seconds by clicking here: http://www.imstilljosh.com/479-2/top-hiv-videos-aids-awareness/.

Yes, You Can Get Syphilis with Oral Sex

What is known is that there is a synergy between HIV and syphilis that can be dangerous and a threat to public health, said Chain. People with HIV and who have a CD4 index (counting blood lymphocytes) below 350 is more likely to develop more advanced stages of syphilis where the infection affects the central nervous system.

And when someone already has syphilis and the lesion is present, known as Cancer, HIV is contracted more easily.

However, the authors of the editorial noted that sexually transmitted diseases are more dangerous in women.

"As highlighted in the editorial, the calculation of risk-benefit in this context are difficult because men are fortunately spared from serious complications of sexually transmitted infections, but the success of these pilot tests should arouse more interest in research as PrEP, along with other interventions can be used to control syphilis, "saidcondom-on-dst Adalja.

Chan said that as much as HIV, syphilis was a very stigmatized disease in the middle of 1900 year. He said 10% of the US population contracted the disease.

However, eventually it became so rare that in 2006 the US government commented on the possibility of eradicates it.

Now the disease returned threatening, along with misconceptions about it, including the illusory belief that you can not contract it by oral sex. You can get updated data on syphilis of the US Centers for Disease Control here: http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm. On the other hand, you can also get information about syphilis on the website of the National STD / AIDS program of the Brazilian Ministry of Health

"Syphilis is one of those fascinating diseases," said Chan.

Translation: Márcio Catanho - Bachelor of Arts / translator and reviewer.

Contacts: mrcatanho@hotmail.com. 085- 88797627.

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