HIV-prevention drug Truvada approved by US

  • sbwlguy

    Posts: 566

    Jul 17, 2012 10:34 PM GMT
    Interesting that is reduces the risk of contracting HIV by up to 73%.

    http://www.bbc.co.uk/news/world-us-canada-18863341
  • gymnerd

    Posts: 136

    Jul 18, 2012 3:37 AM GMT
    at $1000/month, it's probably not going to make it to the highest risk groups. It's a great step and I'm sure cost will drop eventually; until then education, honesty, and safer practices still need to improve...
  • sbwlguy

    Posts: 566

    Jul 18, 2012 5:46 PM GMT
    Jeepers. Didn't realize it costs that much. Nevertheless, 73% is pretty damn good.
  • Suetonius

    Posts: 1842

    Jul 18, 2012 6:08 PM GMT
    sbwlguy saidInteresting that is reduces the risk of contracting HIV by up to 73%.

    http://www.bbc.co.uk/news/world-us-canada-18863341

    Try again - in a study of "gay men" it reduced the risk of getting HIV by only 42%. That's about half. So, on average, you could now be bareback fucked twice as often before you caught it. Now, if only you could be certain of exactly how many times you could bareback with out getting AIDS. Then you could apportion those certain number of times out among only a certain number of very hot men.
  • jim_sf

    Posts: 2094

    Jul 18, 2012 6:54 PM GMT
    GhostCat saidYour assumption about number of times has to be a joke. I don't have a good analogy for that.


    Number of times you can golf during a thunderstorm before being struck?
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    Jul 18, 2012 8:02 PM GMT
    They shouldn't be focusing on treatments and preventions they need a fucking cure.
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    Jul 18, 2012 8:09 PM GMT
    I wonder how many insurance companies will pay for this?
  • jim_sf

    Posts: 2094

    Jul 18, 2012 8:55 PM GMT
    swimguychicago saidI wonder how many insurance companies will pay for this?


    Given the choice between paying for Truvada alone, or Truvada plus other meds plus regular check-ups?
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    Jul 18, 2012 8:58 PM GMT
    Well, this drug should be used with caution. One of the components, Tenofovir, is linked to kidney & liver problems so you would have to monitor your blood chemistry and have routine urinalysis.

    And the cost is rather prohibitive, so insurance companies may be wary to cover it as PrEP.
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    Jul 18, 2012 8:59 PM GMT
    Treatment as Prevention (aka "TasP") will undoubtedly be a key focus of #AIDS2012 in Washington DC.

    Truvada is a first-line antiretroviral (ARV) drug, and is actually 2 medicines in 1 (Tenofovir and Emtricitabine) which is often combined with a 3rd drug for a fixed-dose combination therapy.

    Its the most effective ARV to date, and its recent FDA approval for use as a prevention method is interesting because it builds upon recent 2010 studies that demonstrated that its use could reduce HIV transmission in penile/vaginal sex by up to 96.6%. The rates are different in penile/anal sex because the tissues of the anal membranes are different, more sensitive.

    Anyways, TasP is not new. In fact, this model of using 1 or 2 ARV drugs for preventative measures has been used for Post-Exposure-Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) - especially in the cases of rape, needle-stick injuries, condom breakage, and other scenarios where preventative treatment is administered within 72hrs of high-risk exposure to HIV.

    Its true that strong drugs such as Truvada have long-term impacts on liver and kidney function, and that regular blood enzyme testing is necessary to monitor the patients' health. Cost is prohibitive for out-of-pocked expenses, but could be financed with creative new funding mechanisms either via insurance or public health (consider the relative cost of life-long treatment, as opposed to prevention). But again, this is all known science.

    The new part about this is that its FDA-approved as a prevention method now, and this is no coincidence that it happened 5 days before the start of the AIDS2012 conference next week in Washington.

    TasP is also the biggest news towards a cure that we've had ever. So it should be interesting discussion, because the implication is that if this provides the world with a good option for getting ahead of a 4th decade of new infections, who will pay the bill for it?

    I predict that TasP and funding scenarios will be key themes at the conference.
  • MikemikeMike

    Posts: 6932

    Jul 19, 2012 6:17 AM GMT
    swimguychicago saidI wonder how many insurance companies will pay for this?

    no worries obamacare will give it to you all for freeicon_lol.gif NOT
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    Jul 19, 2012 2:41 PM GMT
    Kingmo,

    I thought the concept of Treatment as Prevention (TasP) was about making sure that HIV-infected individuals received HAART soon after diagnosis since effective treatment can lessen transmission.

    PrEP is prophylactic to prevent infection, not really a treatment.

    Either way, more HIV testing is needed, especially in communities at risk.

    As for Truvada as PrEP, i really hope that Gilead and doctors do follow-up on patients who use Truvada. The thought of Truvada-resistant HIV becoming prevalent does disturb me.
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    Jul 19, 2012 3:49 PM GMT
    medfordguy saidKingmo,

    I thought the concept of Treatment as Prevention (TasP) was about making sure that HIV-infected individuals received HAART soon after diagnosis since effective treatment can lessen transmission.

    PrEP is prophylactic to prevent infection, not really a treatment.

    Either way, more HIV testing is needed, especially in communities at risk.

    As for Truvada as PrEP, i really hope that Gilead and doctors do follow-up on patients who use Truvada. The thought of Truvada-resistant HIV becoming prevalent does disturb me.


    Indeed you're correct - thanks for the clarification. I kinda melded TasP into PrEP and PEP altogether while I was typing fast! In essence, one model begat another.

    PEP (post-exposure) uses 1 or 2 established ARVs for prevention of transmission of HIV, after exposure within 72hrs.

    PrEP (pre-exposure) is what has just been FDA-approved for Truvada. It essentially uses the same model, in that they are using an established ARV for pre-exposure treatment for high-risk groups.

    TasP is the offering of HAART (aka combination ARV therapy) to people immediately upon an HIV+ test, in order to (a) quickly reduce viral load to undetectable levels, and (b) prevent future potential transmission of HIV through that reduction of viral load.
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    Jul 19, 2012 3:53 PM GMT
    kingmo said
    medfordguy saidKingmo,

    I thought the concept of Treatment as Prevention (TasP) was about making sure that HIV-infected individuals received HAART soon after diagnosis since effective treatment can lessen transmission.

    PrEP is prophylactic to prevent infection, not really a treatment.

    Either way, more HIV testing is needed, especially in communities at risk.

    As for Truvada as PrEP, i really hope that Gilead and doctors do follow-up on patients who use Truvada. The thought of Truvada-resistant HIV becoming prevalent does disturb me.




    Indeed you're correct - thanks for the clarification. I kinda melded TasP into PrEP and PEP altogether while I was typing fast! In essence, one model begat another.

    PEP (post-exposure prophylaxis) uses 1 or 2 established ARVs for prevention of transmission of HIV, after exposure within 72hrs.

    PrEP (pre-exposure prophylaxis) is what has just been FDA-approved for Truvada. It essentially uses the same model, in that they are using an established ARV for pre-exposure treatment for high-risk groups. the CDC notes that PrEP is not to be used in isolation, but in concert with other prevention strategies http://www.cdc.gov/hiv/prep/, with a view to accessibility, behaviour, adherence, and other community-level concerns.

    TasP (Treatment as Prevention) is the offering of HAART (aka combination ARV therapy) to people immediately upon an HIV+ test, in order to (a) quickly reduce viral load to undetectable levels, and (b) prevent future potential transmission of HIV through that reduction of viral load.

    As for drug-resistance, it seems to be a risk for any medication which isn't being adhered to in its recommended dosing schedule. We have seen this with other ARVs due to HIV's ability to mutate and therefore develop resistance quickly. (this has been shown to be true for some antibiotics too). So anyone put on PrEP would need to actively monitor with their doctor with occassional lab testing. I think any drug has the potential for resistance to develop.
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    Jul 19, 2012 4:51 PM GMT
    KingMo,

    Good response in clearing up those terms. Its always good when clear info gets out there about HIV and treatment.

    My concern with Truvada-resistance is this: As an HIV positive individual, I have far more incentive to stick to my drug regimen than someone who isn't positive. Taking my medicine does keep me healthy, does keep me alive. That incentive isn't there for PrEP.

    You are right, non-adherence can be a problem even with HAART (for those who don't know, that stands for Highly active anti-retroviral therapy), though it seems that mental/emotional (depression, isolation), drug abuse, and socio-economic (poverty, lack of insurance, access to medical care) play a big role. Which is why AIDS Services Organizations (ASO's) can play a big role in successful HIV treatment.

    I suppose ASO's will have to take some role in PrEP also.