The Truvada Issue

  • Posted by a hidden member.
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    Nov 21, 2012 11:15 PM GMT
    I was just reading the RJ article on use of Truvada as a prophylactic for HIV negative men.
    http://www.realjock.com/article/2003/

    The author discusses the many issues surrounding this, but paints a much rosier picture of it than I have heard before. I remember when the clinical trial was published, but have heard almost nothing about it since. The good news being that it was about as effective as condoms at preventing HIV transmission between + and - LTR partners. (75% The failures on both sides being attributed to people not adhering to the protocol.) The bad news being that the cost is so astronomical that practically nobody can afford it.

    The article makes it sound as if any sexually active negative gay man could and should call up their doctor and get a prescription for this stuff. I have my doubts. The first being whether anybody can afford it. The second being side-effects.

    Press releases from back in July, when the FDA approved the prophylactic use, suggested that it would cost $14,000 per year. Google results have a lot of hits at $11,000, $7000, and even one at $485. Gilead (the manufacturer) is handing out coupons good for $2400 off your first year, so I'm guessing that the lowball headlines are wrong. Has anybody got a firm quote on what the current cost of this stuff is?

    One would think, if Truvada is really effective as a prophylactic, that Wall Street would be shoving money down Gilead's throat to go out and build half a dozen factories to get the unit price down and sell this stuff to every fag on earth. However, there doesn't seem to be all that much excitement about it.

    According to search results, two RJ members are already advertising on their profiles that they use it for prophylaxis.

    Thoughts? Experiences?
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    Nov 21, 2012 11:57 PM GMT
    Poking at this a little more (I'm supposed to be working) it seems like the wheeling-dealing manufacturing angle may be beyond my ken. The patents on Truvada expire in five years, so there may be no incentive to build new plant. That is, the generic manufacturers would take over before they could make back the investment. And something better might come along by then anyway. However, it appears that Truvada is already licensed to generic manufacturers - for the last seven years - but only for sale in the third world. Which may be where the $485 figure comes from.

    Obviously just speculating here. Back to wurk.
  • tiger13

    Posts: 49

    Nov 22, 2012 4:07 AM GMT
    A couple thoughts:


    • I think HIV is the disease that could finally draw sufficient doubt on the modern healthcare industry.
    • A neg friend recently asked his primary care doctor about it, and his insurance company is covering it. He pays a $20-$40 copay per month. I was floored when he told me. I don't think this is usual.
    • The worst thing about Truvada is the GAS. Omg. Bedtime farts like you wouldn't believe.
  • Posted by a hidden member.
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    Nov 22, 2012 5:10 AM GMT
    My interest was piqued from the article on here as well, especially since I live in big, scary NYC. I actually called my insurance to ask how much it would be, and it only amounts to a $25 copay for a month's supply....not that bad at all. I didn't pursue it further, though, because I heard it could have all sorts of nasty side effects and possible complications. Anyone have personal experience or more info? I'm somewhat confused why this isn't causing a bigger stir in the gay community.
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    Nov 22, 2012 5:34 AM GMT
    Are the guys who are using Truvada for HIV prophylaxis using anything for:
    Hepatitis C prophylaxis?
    Penicillin resistant Gonorrhea prophylaxis?
    Azithromycin-resistant syphilis prophylaxis?

    Oh wait! You mean there ARE NO PROPHYLAXIS for these other sexually transmitted diseases????? icon_eek.gif

    Fools will try to fool themselves into thinking foolish behaviour will not beget foolhardy results.

    Get! Fucking! Real! Or you WILL DIE YOUNG AND DISEASED! (READ: UGLY AND DISFIGURED)

    Learn the lessons of the past or be doomed to repeat them over, and over, and over again.

    icon_mad.gif
  • Posted by a hidden member.
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    Nov 22, 2012 5:36 AM GMT
    Whenever I see the word Truvada I keep thinking truvia, the natural sugar substitute.
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    Nov 22, 2012 5:44 AM GMT
    GAMRican saidAre the guys who are using Truvada for HIV prophylaxis using anything for:
    Hepatitis C prophylaxis?
    Penicillin resistant Gonorrhea prophylaxis?
    Azithromycin-resistant syphilis prophylaxis?

    Oh wait! You mean there ARE NO PROPHYLAXIS for these other sexually transmitted diseases????? icon_eek.gif

    Fools will try to fool themselves into thinking foolish behaviour will not beget foolhardy results.

    Get! Fucking! Real! Or you WILL DIE YOUNG AND DISEASED! (READ: UGLY AND DISFIGURED)

    Learn the lessons of the past or be doomed to repeat them over, and over, and over again.

    icon_mad.gif


    Sounds spot on to me
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    Nov 22, 2012 5:44 AM GMT
    One of the most common side effects is stomach pain. It is a harsh medication for some to take, so it's not for eveyone. If you don't want to contract HIV, just simply do not perform unprotected sex and that includes oral sex (unless you are 100% sure your mucous membrane does not have cuts). A lot of doctors are actually not fond of this prevention technique as it increases people's tendency to practice unprotected sex and thus other STI are spread instead.

    20-25$ a month of Truvada is not much compare to a real HIV patient that are on stronger antiviral medication that cost them about 700$/year and the rest covered by insurance.

    Moral of the story, consult a doctor ASAP if you believe your partner is HIV + and you had unprotected sex so you'll probably be started on this med. Or just condom condom condom.
  • Posted by a hidden member.
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    Nov 22, 2012 5:50 AM GMT
    Can't access the text of the studies; but I'm amazed than they allowed double blind placebo study.

    It translate as : they made a study where subject where given pill, knowing it can be treatment of placebo, and asked to keep having unsafe sex ? Nobody see a ethical problem here ?????

    Next, an important element of FDA drug approval is for the drug to demonstrate a better benefits/side effect ratio than available treatments on the market.
    If we stretch it as far as Truvada promoter, it's as best as protective as condoms, yet with a lot more side effect, not even taking into account it doesn't preserve you from other sexually transmissible diseases.

    Truvada, for me, make sens only for two categories :

    * guys paranoid about HIV, who will use it in addition to condoms, in case the condom brake.

    * guy who are adamant about bareback anal sex.

    If you are not on those two extreme side, I can't see the point in using the drug.
  • Posted by a hidden member.
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    Nov 22, 2012 6:09 AM GMT
    A few months ago, the group they were proposing it for was negative people who are married to positive people.

    Since there seems to be a significant group of guys who just won't use condoms, there could be public health benefit in getting an effective prophylactic to that group. Another question is would those guys even use it correctly, if they were provided. Sort of by definition, not the most responsible bunch.

    Maybe they should just quietly spike the vodka at all the gay bars.
  • dfrourke

    Posts: 1062

    Nov 22, 2012 6:12 AM GMT
    Hmmmm...

    As someone who takes drugs every day because of a decision I can't take back, I wish now I didn't have to but something in my body to stay health. I would choose the non-invasive approach. Hindsight is always 20/20...

    That being said, I believe in meeting folks where they are...if Truvada is going to help someone stay negative (at least for HIV), then I think all options need to be on the table without judgment...

    "Just say no"...reached a very small percentage of folks in the 80's as a deterrent for drug use...

    "use a condom"...isn't going to reach everyone...

    I don't believe Truvada is a perfect solution, it doesn't protect you from non-HIV disease and it is another chemical your liver has to synthesize and not without its own side effects...but these days, as an HIV counselor, I keep all of the ammunition on the table in the fight against HIV.

    - David icon_wink.gif
  • tiger13

    Posts: 49

    Nov 22, 2012 7:45 PM GMT
    Steduo said (emphasis mine)One of the most common side effects is stomach pain. It is a harsh medication for some to take...


    Agree. We don't know/understand the long term effects of this stuff... I mean, they are disrupting the normal operation of human cells. There can't be any unexpected issues there :-)

    ...I say as I take my two pills a day, three M/W/F. And injections. And other meds.
  • FitGwynedd

    Posts: 1468

    Nov 22, 2012 7:51 PM GMT
    mindgarden saidI was just reading the RJ article on use of Truvada as a prophylactic for HIV negative men.
    http://www.realjock.com/article/2003/

    The author discusses the many issues surrounding this, but paints a much rosier picture of it than I have heard before. I remember when the clinical trial was published, but have heard almost nothing about it since. The good news being that it was about as effective as condoms at preventing HIV transmission between + and - LTR partners. (75% The failures on both sides being attributed to people not adhering to the protocol.) The bad news being that the cost is so astronomical that practically nobody can afford it.

    The article makes it sound as if any sexually active negative gay man could and should call up their doctor and get a prescription for this stuff. I have my doubts. The first being whether anybody can afford it. The second being side-effects.

    Press releases from back in July, when the FDA approved the prophylactic use, suggested that it would cost $14,000 per year. Google results have a lot of hits at $11,000, $7000, and even one at $485. Gilead (the manufacturer) is handing out coupons good for $2400 off your first year, so I'm guessing that the lowball headlines are wrong. Has anybody got a firm quote on what the current cost of this stuff is?

    One would think, if Truvada is really effective as a prophylactic, that Wall Street would be shoving money down Gilead's throat to go out and build half a dozen factories to get the unit price down and sell this stuff to every fag on earth. However, there doesn't seem to be all that much excitement about it.

    According to search results, two RJ members are already advertising on their profiles that they use it for prophylaxis.

    Thoughts? Experiences?


    It will likely be in use in the UK soon if it isn't already, because of the fact that annual costs for long term care of HIV patients will drastically exceed that the cost of the medication. Since the American system is a business and not a service model I don't know if an HMO will cover it.
  • Posted by a hidden member.
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    Nov 22, 2012 8:43 PM GMT
    tiger13 said
    Steduo said (emphasis mine)One of the most common side effects is stomach pain. It is a harsh medication for some to take...


    Agree. We don't know/understand the long term effects of this stuff... I mean, they are disrupting the normal operation of human cells. There can't be any unexpected issues there :-)

    ...I say as I take my two pills a day, three M/W/F. And injections. And other meds.


    Can you elaborate on that? As I understand it, these reagents are supposed to be specific to the viral reverse transcriptase. Is there evidence that they inhibit any human enzymes? Otherwise, I agree about unknown long-term effects.


    BTW: There are some signs that up to 40% of the human genome may be old retroviruses. Nobody knows what they do or if they could hop back out and become viruses again icon_eek.gif
  • Posted by a hidden member.
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    Nov 23, 2012 9:22 AM GMT
    I've had to take Truvada. I didn't experience any side effects. But I'm a rare case.

    Anyway this isn't the first time I've had to take it (or something like it) another time was when I was a kid, it was still incredibly experimental and they just didn't know if it'd work or not but they tried it. The side effects on that where horrendous, terrifying and completely soul destroying.

    Everyone is different.

    Don't throw your life on the line for an hour of fun.
  • mr_bijae

    Posts: 229

    Nov 23, 2012 9:28 AM GMT
    GAMRican saidAre the guys who are using Truvada for HIV prophylaxis using anything for:
    Hepatitis C prophylaxis?
    Penicillin resistant Gonorrhea prophylaxis?
    Azithromycin-resistant syphilis prophylaxis?

    Oh wait! You mean there ARE NO PROPHYLAXIS for these other sexually transmitted diseases????? icon_eek.gif

    Fools will try to fool themselves into thinking foolish behaviour will not beget foolhardy results.

    Get! Fucking! Real! Or you WILL DIE YOUNG AND DISEASED! (READ: UGLY AND DISFIGURED)

    Learn the lessons of the past or be doomed to repeat them over, and over, and over again.

    icon_mad.gif


    WARNING: LOVE (AND LUST) CAN CAUSE FOOLISH BEHAVIOR...
  • tiger13

    Posts: 49

    Nov 23, 2012 7:40 PM GMT
    mindgarden said
    tiger13 said
    Steduo said (emphasis mine)One of the most common side effects is stomach pain. It is a harsh medication for some to take...


    Agree. We don't know/understand the long term effects of this stuff... I mean, they are disrupting the normal operation of human cells. There can't be any unexpected issues there :-)

    ...I say as I take my two pills a day, three M/W/F. And injections. And other meds.


    Can you elaborate on that? As I understand it, these reagents are supposed to be specific to the viral reverse transcriptase. Is there evidence that they inhibit any human enzymes? Otherwise, I agree about unknown long-term effects.


    Also as I understand it. I'm just a little skeptical that we really understand it icon_smile.gif

    mindgarden said
    BTW: There are some signs that up to 40% of the human genome may be old retroviruses. Nobody knows what they do or if they could hop back out and become viruses again icon_eek.gif


    Indeed. I find this quite fascinating.
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    Jan 08, 2013 5:32 AM GMT
    minox said
    Truvada, for me, make sens only for two categories :

    * guys paranoid about HIV, who will use it in addition to condoms, in case the condom brake.

    * guy who are adamant about bareback anal sex.

    If you are not on those two extreme side, I can't see the point in using the drug.



    I am actually taking Truvada and Reyetaz as treatment for HIV. I don't have any of the side effects that I can notice. On this treatment my Viral dropped from 5900 to undetectable in less then one month. In 6 months CD4 went from 460 up to 580 in december. This treatment works pretty well for me at this time. Everyone is different though.
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    Jan 08, 2013 5:35 AM GMT
    dfrourke said...but these days, as an HIV counselor, I keep all of the ammunition on the table in the fight against HIV.

    - David icon_wink.gif


    Thank you for your work, and I'm sure those you counsel thank you as well.
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    Jan 11, 2013 12:00 PM GMT
    I went to get my quarterly HIV test yesterday and I tested negative. I am in a monogomous relationship for the last three months now and I hadnt had any sex for about 2-3 months prior but I admitted to a history that goes back hundreds of men (99% married and "straight") and women over the past 7 years.

    The health care professional who did my HIV test suggested I down load the application and get on Truvada because of my past slutty behavior.

    I read the article posted here also and appreciate all the input.

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    Jan 11, 2013 12:43 PM GMT
    BeachBiMan saidI went to get my quarterly HIV test yesterday and I tested negative. I am in a monogomous relationship for the last three months now and I hadnt had any sex for about 2-3 months prior but I admitted to a history that goes back hundreds of men (99% married and "straight") and women over the past 7 years.

    The health care professional who did my HIV test suggested I down load the application and get on Truvada because of my past slutty behavior.

    I read the article posted here also and appreciate all the input.



    WTF? You're HIV-, are in a monogamous relationship, didn't have sex for 2-3 months prior and your health care professional is recommending Truvada????

    Get a second opinion.
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    Jan 11, 2013 2:27 PM GMT
    GAMRican saidAre the guys who are using Truvada for HIV prophylaxis using anything for:
    Hepatitis C prophylaxis?
    Penicillin resistant Gonorrhea prophylaxis?
    Azithromycin-resistant syphilis prophylaxis?

    Oh wait! You mean there ARE NO PROPHYLAXIS for these other sexually transmitted diseases????? icon_eek.gif

    Fools will try to fool themselves into thinking foolish behaviour will not beget foolhardy results.

    Get! Fucking! Real! Or you WILL DIE YOUNG AND DISEASED! (READ: UGLY AND DISFIGURED)

    Learn the lessons of the past or be doomed to repeat them over, and over, and over again.

    icon_mad.gif


    Well stated.
  • Posted by a hidden member.
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    Jan 11, 2013 3:07 PM GMT
    GAMRican said
    BeachBiMan saidI went to get my quarterly HIV test yesterday and I tested negative. I am in a monogomous relationship for the last three months now and I hadnt had any sex for about 2-3 months prior but I admitted to a history that goes back hundreds of men (99% married and "straight") and women over the past 7 years.

    The health care professional who did my HIV test suggested I down load the application and get on Truvada because of my past slutty behavior.

    I read the article posted here also and appreciate all the input.



    WTF? You're HIV-, are in a monogamous relationship, didn't have sex for 2-3 months prior and your health care professional is recommending Truvada????

    Get a second opinion.


    Thanks I will do just that, I don't like taking any drugs.
  • Posted by a hidden member.
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    Dec 31, 2013 9:47 PM GMT
    Another year has gone by, and this story in todays NYT expresses astonishment that gay men are not rushing to sign up for PrEP. Odd that they don't see the fundamental mismatch between "$1000 per month" and the likely finances of the target population.

    According to the manufacturer, since 2011, only 1774 people (except for the study groups) have filled prescriptions, and half of those were women married to HIV+ men.
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    Dec 31, 2013 9:54 PM GMT
    Maybe because they're using condoms already? And the barebackers, who knows what they're thinking.