Talk:Pre-exposure prophylaxis

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OUT OF DATE[edit]

This entry is surprisingly out of date; PrEP is not longer experimental, having been approved by the FDA in 2012; several studies have further attested to its effectiveness; other studies have shown no increase in risky behavior; but the newest studies cited in the article are well out of date. Can someone help?

Dpmath (talk) 05:41, 24 April 2014 (UTC)

EDITORS: THIS ARTICLE IS ALMOST DANGEROUSLY OUT OF DATE WITH CDC GUIDELINES[1]! CAN SOMEONE TAG IT?

  1. ^ "Pre-Exposure Prophylaxis (PrEP)". Centers for Disease Control and Prevention. 

— Preceding unsigned comment added by 70.111.150.118 (talkcontribs) 21:04, 2 September 2014‎

I just updated it a bit. Blue Rasberry (talk) 23:42, 28 December 2014 (UTC)

Use in dentistry[edit]

Might be worth noting that this technique is also in use when there is a risk of transmitting a disease during a medical procedure. Specifically, its use in dentistry. Take a look here. Muuon (talk) 08:11, 19 November 2007 (UTC)

What is up with this page?[edit]

This article is perplexing.

  1. My understanding is that the difference between prophylaxis and vaccines is that vaccines have a lasting effect, whereas prophylaxis is effective only while on treatment. As such, I removed the editorial sentence about a Herpes vaccine being "good news," and the empty HPV section (which I assume was intended to be about Gardasil.)
  2. Yes, I suppose anti-malarials are a form of pre-exposure prophylaxis for malaria, but I've never heard them called "PrEP" or "pre-exposure prophylaxis." To my knowledge, PrEP refers exclusively to the use of antiretrovirals prior to HIV exposure, and I am able to find zero references that indicate otherwise. I am tempted to remove every reference to prophylaxis for infections other than HIV from this article unless someone can produce a source indicating that "PrEP for Malaria" is a thing anywhere other than on Wikipedia.
  3. The 'criticism' section is... odd. I'm not sure what criticism it was originally intended to discuss (perhaps the mythical Truvada whore?) but in its current form I think it should be killed with fire. What is there to criticize about a drug that prevents AIDS, anyway?

So, yeah. What do you think? betafive 09:42, 14 August 2014 (UTC)

I ran a Google scholar search, "pre-exposure prophylaxis" -hiv, to find papers on pre-exposure prophylaxis for infections other than by HIV. This yielded articles on pre-exposure prophylaxis for numerous diseases including rabies, viral hepatitis, Burkholderia pseudomallei, human papillomavirus, laboratory-acquired leptospirosis, influenza A, and tick-borne encephalitis, as well as for the effects of exposure to ricin and tear gas.
I think the Criticism section is self-explanatory. For one thing, any preventive that has its own risks is subject to criticism (if the vaccine for measles killed one out of every five people to whom it was given, it would be heavily criticized); the research used to support the recommendation of any practice is subject to criticism of its methodology, its execution, and the reasoning used to draw conclusions; the presentation of PrEP for HIV is subject to criticism, as when it gives the impression that it provides greater protection than condoms when used instead of condoms, which may not be true; and so forth.
—Largo Plazo (talk) 10:34, 14 August 2014 (UTC)
Interesting. Two new questions, then:
  1. Are any of them referred to as "PrEP," or is that term specific to HIV pre-exposure prophylaxis (as the CDC seems to think)?
  2. Did you find any real criticism of PrEP? As it is currently written, the "Criticism of PrEP" section doesn't contain actual criticism, so if that section is appropriate and encyclopedic, it would be helpful to find some to put there. Otherwise, I still think it should be kilt with fire.
betafive 12:09, 14 August 2014 (UTC)
It doesn't matter whether they refer to it as "PrEP". The title of this article is "Pre-exposure prophylaxis".
Most of what's in the Criticism section is criticism. I don't understand where you're coming from on that. Referring to your edit summary, side effects are certainly a legitimate basis for criticism. Did you not get my point about, for example, criticizing a preventive for causing more problems than it prevents like, for example, killing people? —Largo Plazo (talk) 12:25, 14 August 2014 (UTC)
  1. Sure it does. "PrEP" is a redirect to this article, the very first sentence says "Pre-exposure prophylaxis (PrEP)...", and, uh, it's in all the section names. If the term "PrEP" is unique to pre HIV exposure prophylaxis, then this article as currently written is misleading.
  2. Actually, none of what's in the criticism section is criticism of PrEP. There is a description of the side-effects as minor and transient, there's a criticism of the study participants for failing to comply with their prescribed regimen, there are vague and weasel-worded "concerns" about delivery, and there is the preliminary result of a CDC trial which appears to show that PrEP does not increase the prevalence of risky sex. Your point doesn't make any sense; are you implying that PrEP kills people? That would be a legit criticism of PrEP. We'd need a RS for it, though. betafive 12:49, 14 August 2014 (UTC)
Redirecting from a narrow topic without its own article to an article on an encompassing topic is a common and ordinary occurrence that in no way implies that the general articles are supposed to be restricted in their scope by the narrower scope of the redirected topics. Tergeo redirects to Harry Potter, but surely no one thinks that the scope of Harry Potter should therefore be limited to coverage of the Tergeo spell.
No doubt the article has had both contributors who were unaware of the concept, or at least the term, "pre-exposure prophylaxis" prior to its use for the HIV prevention regimen and are under the impression that the term goes hand-in-hand with HIV; and contributors who know the term as the more general one that it is. I also don't know whether the abbreviation "PrEP" was prevalent before its application to HIV. Therefore, no doubt that the article reflects this confusion. If, in fact, "PrEP" is termed as such only in the context of the HIV prevention protocol, then the article may need some editing to clear away misassociations among things and get everything straightened out.
I didn't say PrEP causes death. But if you agree with the proposition that if death was a common side effect from some preventive treatment it might be the basis for criticism of that treatment, then we can dispense with your dismissive, blanket "side effects aren't criticism" and recognize that a mention of side effects being raised as a cause for concern with this preventive measure fits the definition of the word "criticism". —Largo Plazo (talk) 13:59, 14 August 2014 (UTC)
If "PrEP" is not in common currency to refer to pre-exposure prophylaxis for illnesses other than HIV, the introduction of this article needs to be changed to not imply that the terms are synonymous, and all references to "PrEP for X" where X is not HIV need to be altered to instead say "pre-exposure prophylaxis for X."
Chemotherapy actually can cause death. If you look at Chemotherapy, you'll notice there's no criticism section; it's called "adverse effects." HRT can also cause death. You'll notice that none of the hormone replacement therapy articles have criticism sections. This article should not have such a section either.
Do you agree? betafive 18:20, 15 August 2014 (UTC)
'If "PrEP" is not in common currency to refer to pre-exposure prophylaxis for illnesses other than HIV, the introduction of this article needs to be changed to not imply that the terms are synonymous ....' Yes, that's what I said.
So in another article someone put the same sort of analysis under a different heading. That is immaterial. How is the question of whether a given article should have a section on criticisms to which its topic has been subjected, or the question of whether that section should be called "Criticism", dependent on whether or not some editor has seen fit to create a section with the same heading in any other article you might point to? —Largo Plazo (talk) 18:42, 15 August 2014 (UTC)
"Claritin causes dry mouth" is an adverse effect. "Laetril doesn't work" is a criticism. Does that clear things up? This criticism section isn't critical. betafive 20:51, 15 August 2014 (UTC)
"Claritin may cause fat redistribution, lymphoma, violent dreams, and suicidal thoughts" is a criticism if it's being argued that those side effects are worse than the condition for which Claritin is being advocated. —Largo Plazo (talk) 22:05, 15 August 2014 (UTC)
Wikipedia doesn't argue, it presents information. Are there reliable sources critical of PrEP? If not, the criticism section has no place here. betafive 22:29, 15 August 2014 (UTC)
Nearly everything in the section is sourced and nearly all of it is significant. It is true that some of it is in the form of something one would say to respond to a criticism, and some of implies a possible source of criticism without citing a criticism. So clean-up and reorganization are called for, but not outright obliteration of the content of that section. —Largo Plazo (talk) 22:38, 15 August 2014 (UTC)

────────────────────────────────────────────────────────────────────────────────────────────────────Fine, let's do this.

The first full paragraph would do well under the section heading "Adverse effects." None of it is critical of PrEP:

  • The PrEP studies have shown the drugs to be safe, with few side effects. is praise, not criticism.
  • Generally, minor side effects such as nausea or diarrhea resolve themselves within the first few months.[9] Effects of Truvada on kidney function have been shown to be temporary.[11] The level of effectiveness depends on the degree of adherence to the prescribed regimen. In iPrEx, persons with greater than 90% adherence to the drug had an efficacy of 68% protection versus persons with less than 50% adherence who had an efficacy of 16%. are all facts, not criticism.
  • Furthermore, the FEM-PrEP trial that was stopped early due to futility, found that the women's adherence to the drug was too low to find any effect on reducing HIV infections. is a criticism of women's adherence to the study protocol, not of PrEP.

The second paragraph is a transparent contrivance that fails WP:SYNTH:

  • Given mounting evidence of the effectiveness of PrEP among different populations when the drug is taken correctly, concern has turned more towards the practicalities of implementing PrEP as prevention. Whose concern? The editorial voice does not express concern.
  • Since approximately 60% of people needing anti-retroviral therapy are not getting it, there are concerns that trying to deliver PrEP to many more people would be challenging. What the fuck? That doesn't follow.

Looking at the given source, we see this:

A major issue is how to roll out PrEP programs when there is a global post-infection treatment gap. Currently, we need to expand antiretroviral therapy access to the approximately 60% of HIV-infected individuals who are eligible for treatment but are not receiving it. The challenge of offering PrEP in this context should be reframed away from "prevention versus treatment" to "treatment and prevention, in parallel." To achieve this, we need to reduce antiretroviral therapy delivery costs, address the treatment gap, improve retention in care, and optimize the clinical and public health benefits of antiretroviral therapy. We also need to initiate pilot programs of cost-effective PrEP delivery models and shift prevention resources to fund strategies that actually work.

While that certainly is criticism, it is not critical of PrEP. Rather, it is criticism of our healthcare delivery model, wherein PrEP is suggested as a means of its improvement. Something of a different bias, eh?

Lastly:

  • Effects of PrEP on behavioral changes, such as decreased condom use, are currently being studied. The CDC is conducting an extended safety trial in the U.S. to determine if men taking the drug who have sex with men are more likely to engage in risky behaviors; preliminary results do not show any change in behavior. totally fails WP:DUE, to say nothing of the POV-pushing implications.

So, there it is. The section sucks and needs to be killed with fire. I'm sorry you don't like my tone; my heartfelt suggestion is that you get over it. betafive 04:56, 16 August 2014 (UTC)

I do not mind your tone, but critical attitudes sometimes are met with encouragement to write content for an article. Why not add what you want to the article? Blue Rasberry (talk) 12:57, 16 August 2014 (UTC)
Sorry, that comment was in response to Largo's previous edit summary. I'm intending to expand the article, and hopefully split PrEP off from pre-exposure prophylaxis for things other than HIV, but that section needed some heavy copyediting first. betafive 15:53, 16 August 2014 (UTC)

Perhaps this article should only be about HIV[edit]

The phrase "pre-exposure prophylaxis" could mean anything, but practically all sources now use this only to refer to preventing HIV. Here are some other prophylaxis articles:

I am not convinced that any of these names are best for these articles, because they could use other names which have clearer meaning than prophylaxis.

I am thinking of making this article entirely about HIV, because even though the term "pre-exposure prophylaxis" was occasionally used historically in other contexts no other use was well-established, and now the use for HIV is international. Blue Rasberry (talk) 21:14, 28 December 2014 (UTC)