This Week in PLOS Medicine: Couples & HIV Prophylaxis (PrEP), Smokeless Tobacco, & Controlling Cholera Outbreaks

This week PLOS Medicine publishes the following new articles:

Image credit: CDC

Image credit: CDC

Several trials in various at-risk populations have shown that antiretroviral pre-exposure prophylaxis (PrEP) has provided varying levels of protection against HIV infection. One explanation for this varying efficacy is differential adherence to antiretroviral drugs. Studying Ugandan heterosexual serodiscordant couples (couples where only one partner is HIV positive), Jessica Haberer and colleagues report that high adherence to PrEP, achieved in the setting of active adherence monitoring and counseling support, is associated with a high level of protection from HIV acquisition by the HIV-uninfected partner. Adherence to antiretroviral drugs was very high in this study, and only 14 individuals became HIV-positive during an average follow up of 11 months (and all of these individuals were taking a placebo). These findings provide further support that PrEP is highly efficacious at preventing HIV acquisition when it is taken. Proper support and assessment of adherence will be critical for determining efficacy of PrEP outside of clinical trials.

In light of lobbying by transnational tobacco companies to remove the European Union ban on the sale of snus (a smokeless tobacco product), Silvy Peeters and Anna Gilmore explore the motivation behind tobacco companies’ interests in smokeless tobacco products in Europe. Analyzing internal tobacco industry documents made available by litigation alongside contemporary industry documentation, the authors report evidence that transnational tobacco companies’ early interest in introducing smokeless tobacco in Europe was based on the potential for creating an alternative form of tobacco use, in light of declining cigarette sales and social restrictions on smoking.  These findings indicate that the industry’s rhetoric on harm reduction is inconsistent with historical and recent documents and business actions. The authors conclude that, by investing in snus and recently nicotine, transnational tobacco companies have eliminated competition between cigarettes and “lower-risk” products, while ensuring transnational tobacco companies’ long-term future should cigarette sales decline further and profit margins be eroded.

Iza Ciglenecki and colleagues from Médecins Sans Frontières (Doctors without Borders) describe their experience of undertaking the first mass vaccination campaign using oral cholera vaccines in response to an outbreak in Guinea. The authors report that the campaign was well accepted by the population, demonstrated by high vaccination coverage despite the remote rural setting. The authors conclude that oral cholera vaccines are a promising additional tool for controlling cholera epidemics and should help prevent many illnesses and deaths, especially in settings with limited access to health care and where immediate improvements in sanitary conditions are improbable.

 

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