text: Thirty-two years after the AIDS virus was first discovered, the findings of a new study done by Kaiser Permanente prove HIV is 100 percent preventable.More than 600 patients have been on the drug Truvada for about three years and none has tested positive for HIV.The results of those clinical trials showed that Truvada was effective in more than 90 percent of patients. Since then, Kaiser Permanente in San Francisco has been giving the drug to its patients for more than two years with even better results.Doctor Jonathan Volk put Kaiser Permanente patients, at risk for HIV, on the medication. Patients like Paul Marcelin were put on a daily regimen of the drug Truvada, which has proved in clinical trials to protect a vast majority of people from HIV infection."It's wonderful to have less worries about HIV. It's something that is always lurking in the back of one's mind," Marcelin said.Instead of protecting most people, Kaiser Researchers found the drug has been 100 percent effective. Their patients have been taking it since the drug was approved in 2012. Their findings appear online in the Clinical Infectious Diseases Advance Access."We now have over 600 patients using this medication and no new HIV infections," Volk said.Patients are tested every three months for HIV and monitored for any possible side effects. Those include gay and bisexual men, as well as heterosexuals and injection drug users."What's really exciting about HIV prevention in 2015 is that we have options, we have several tools that we can use," Volk said.The study suggests that HIV is very close to being managed like any other chronic disease, such as diabetes or asthma. ||||| HIV-preventing drug holds up under study 
   
   Truvada, a daily pill that holds the hope of eliminating the risk of contracting HIV, appears to be living up to its promise. 
   
   In the first real-world study of the prescription drug, Kaiser researchers found no new HIV infections among the more than 650 people they followed over nearly three years, beginning just after the drug was approved by the U.S. Food and Drug Administration in 2012. 
   
   A clinical trial leading up to the FDA approval had shown that Truvada, made by Foster City’s Gilead Sciences, nearly eliminated the risk of getting infected by the AIDS virus. But no evaluations of the drug, also known as PrEP, for pre-exposure prophylaxis, had been published outside the tightly regulated clinical trial setting. 
   
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   In the new study, participants were sexually active. Many did not use condoms for prevention, and half of them were diagnosed with other sexually transmitted diseases within a year of starting the study. But no new HIV infections turned up, researchers said. 
   
   “This is really compelling data that shows that PrEP works in a real-world setting,” said Dr. Jonathan Volk, a San Francisco Kaiser physician and epidemiologist and lead author of the study, which was published Wednesday in the medical journal Clinical Infectious Diseases. 
   
   Truvada, which contains the antiviral drugs emtricitabine and tenofovir, was originally created as an anti-retroviral drug used to treat HIV, but it has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent when taken consistently, according to the U.S. Centers for Disease Control and Prevention. 
   
   Drug has its critics 
   
   Still, the drug, which costs Kaiser patients about $50 a month, is not without controversy. PrEP was criticized early on by health providers and other advocates over concerns that the drug would encourage unsafe sex because of a false sense of security. In fact, the Kaiser study did find a significant decrease in condom use among the participants. 
   
   One of the loudest critics has been Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles, who has publicly called Truvada a “party drug.” While PrEP may be an option for high-risk individuals who don’t use condoms, he said last month, it should not be used as community-wide public health intervention strategy. 
   
   But the CDC and public health advocates disagree. 
   
   The CDC last summer recommended the drug as a prophylactic for those at highest risk of becoming infected — sex workers, men with HIV-positive partners or those who engage in high-risk behaviors, such as IV drug use — and under careful watch by their doctors. San Francisco health advocates have also recognized Truvada as an important tool for the city’s Getting to Zero program, which aims to make the city the first in the country to have no new HIV infections, deaths or stigma. 
   
   “We have a fantastic new tool we can be using to help our patients protect themselves from HIV,” Kaiser’s Volk said. “I don’t think PrEP is right for everybody. But for the folks who need it, it works.” 
   
   No new infections seen 
   
   To test the effectiveness of the drug, Kaiser researchers identified 657 Kaiser San Francisco patients and followed them over 32 months without requiring anything after their initial screening other than regular testing for sexually transmitted diseases and completing an occasional questionnaire. The average age was 37, and 99 percent were men who have sex with men. 
   
   The study did not have a control group for the sake of comparison, but the participants clearly weren’t abstinent. After six months, about 30 percent of the PrEP users had been diagnosed with at least one sexually transmitted infection, with that number rising to 50 percent after a year. But there were no HIV infections, the study found. 
   
   When the participants were asked about any changes in behavior, 74 percent reported no change in their number of sexual partners, while 15 percent reported a decrease and 11 percent said the number increased. Condom use was unchanged in 51 percent of the participants, while 41 percent said they had decreased their condom use and 3 percent had increased the use of condoms. 
   
   “We know adherence to the medication is a really importance piece,” Volk said. “The fact we had no new HIV infections is very encouraging, but we still have more to learn about how people are using this medication.” 
   
   ‘At high-risk phases’ 
   
   For study participant Paul Marcelin, a San Francisco Kaiser patient who lives in Alameda, the drug allows him to protect himself while maintaining his relationship with his HIV-positive boyfriend. “I felt very comfortable that we don’t worry the same way that some couples might,” he said. 
   
   Marcelin, 40, a database expert, participated in a separate PrEP study conducted in 2013 by the San Francisco Department of Public Health and stayed on the drug for the Kaiser study. He said he thinks any hesitancy about Truvada is starting to dissipate, and people are accepting it as another prevention option. 
   
   “PrEP is something you can choose to use when at high-risk phases in your life,” he said. “I’m in a phase of my life I need to use it, but I won’t always be.” 
   
   Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com Twitter: @vcolliver
target: – Big news in the fight against HIV: Kaiser Permanente, San Francisco's biggest private insurer, says that over a 32-month period, not a single one of its clients taking Truvada contracted HIV. Truvada is the name of the daily pre-exposure prophylaxis, or PrEP, pill that the CDC recommended for use in at-risk populations earlier this year. The new study followed 657 San Franciscans (all but four of them gay men) who asked their doctors for Truvada, and found that while condom use did decline—a major fear of PrEP critics—no one contracted HIV between mid-2012 and February of this year, the New York Times reports. More than 40% of the subjects said they used fewer condoms after starting Truvada, the San Francisco Chronicle reports, and while half of the subjects got syphilis, gonorrhea, or chlamydia within a year of starting PrEP, the Times notes most sexual infections other than HIV can be cured with antibiotics. And rates of those infections were already climbing among gay men before PrEP came on the market, a doctor notes. This was an observational study of the $50-a-month drug; a clinical trial last year actually gave some participants a placebo instead of Truvada. That study, however, was stopped early—because it became so obvious that Truvada worked that it was unethical to keep some of the subjects on a placebo. This new study "takes it out of the realm of clinical trials and into the real world," one doctor and infectious disease expert says. An AIDS activist echoes that, noting the study "fills in a critical gap by showing that PrEP can prevent infections in a real-world public health program." "This is very reassuring data," adds the lead author of the new study. "It tells us that PrEP works even in a high-risk population." According to ABC 7, the study population also included "injection drug users."