Washington Post (12.22.04) - Wednesday, December 22, 2004
Craig Timberg

About 125 prostitutes from several brothels in Ibadan, Nigeria, have enrolled and have been taking pills since July. No trial participants know whether they are taking a placebo or tenofovir. They are counseled and given unlimited condom access. But in a city where 22 percent of sex workers have HIV, researchers expect some to contract HIV during the trial.

Researchers say daily tenofovir could stop HIV in the first steps of infection, when the virus turns host cells into HIV factories. A 1995 tenofovir trial stopped the simian strain of HIV from infecting monkeys. A similar approach has succeeded in preventing HIV infection among rape victims and medical workers exposed to the virus.

If tenofovir prevents HIV infection and high-risk groups can be persuaded to take a pill for protection, researchers say HIV's devastating global spread could be slowed. Married women especially are among the most vulnerable to infection, because husbands who are unfaithful may be unlikely to warn them or take precautions. Women could take the drug without a husband or sex partner knowing.

The $50 million trial is being funded by CDC, the National Institutes of Health and the Bill & Melinda Gates Foundation. Trials are beginning in Nigeria, Ghana, Cameroon, Malawi, Botswana and Thailand, as well as in Atlanta and San Francisco.

Trial critics ask if healthy people can safely and practically take the drug long-term, especially in Africa and other developing areas where such practice is uncommon. Sporadic use could encourage HIV resistance or offer only partial protection, researchers say. Others ask if giving half of volunteers a placebo rather than a drug that could save their lives is unethical.

Placebo recipients would be less likely to get HIV because they receive counseling and condoms, said Ward Cates, president of Family Health International, which is overseeing several of the trials. However, researchers rejected as too costly guaranteed lifetime medical treatment for any participants infected during the study - a demand of some AIDS activists.
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