10 ms·

A Blue Pill Is Stopping HIV, World-First Study Shows

130 points by startupflix 8y ago

stephengillie 8y ago
Corroboration from a more reliable news source than Bloomberg: https://m.indiatimes.com/health/buzz/this-blue-pill-has-been-proving-to-halt-the-spread-hiv-in-its-tracks-355092.html https://m.indiatimes.com/health/buzz/this-blue-pill-has-been...
Retric 8y ago
Graph seems to be comparing 6 months of 2018 with full years before that which would vastly overstate the decline.
- akovaski 8y ago
  This is misleading to the point that I would consider this lying to the audience. It's just wrong to convey the data in this way. The note below the graph does not make this OK. If anybody is interested in the actual data, I think the data is pulled from "NSW HIV Surveillance Data Reports": https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data.aspx https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data...
  - thanatosmin 8y ago
    Yep, look at Figure 1: https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018-nsw-hiv-data-report.pdf https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018... The trend seems to be downward, but it's more like ~10% in the past couple years than a step change.
- jliptzin 8y ago
  Thanks, I overlooked that myself, and is definitely misleading.
DenisM 8y ago
Developed by Gilead, the same company that created the Hep-C cure Sovaldi. Some kick-ass work there.
- tpetry 8y ago
  Have been googling Solvadi. Wow, curable hepatitis c is a big achievemt. But it‘s insanely expensive. It has to be taken daily for at least 12 weeks, with each pill costing 400€! The chance of curing is at 90%.
  - DenisM 8y ago
    It was $100k per course at the time of introduction in the US, which resulted in a lot of hate. But it is a miracle. A close relative of mine was cured, and it had a profound effect on her quality of life. Gilead has very different prices in different regions, we sourced from a place that was much cheaper.
    - exhilaration 8y ago
      Since your relative is cured, I don't think there's any harm in telling us what country you sourced the drug from.
      - DenisM 8y ago
        India.
  - tptacek 8y ago
    That sounds pretty inexpensive. It looks like the previous standard of care cost $10-15,000 and wasn't generally curative. Meanwhile, the long-term cost of a progressing hep-c infection is quite high.
    - metildaa 8y ago
      In the context of a decietful medical system that bills pie in the sky amounts for rendering basic care, a $100k cure for Hepatitis C might seem reasonable. But those who need it most are dying due to this pricing scam, which is standard for our healthcare in the US.
matthewmacleod 8y ago
The effectiveness of the tenofovir and emtricitabine combination is hard to overstate. Other studies show almost 100% prevention of infection; to my knowledge there have only been two recorded infections in people who were reliably taking PReP, both of which were due to unusual, rare mutations. This sort of thing is a step change for vulnerable populations; hopefully it ends up being widely accessible. The combination of this and aggressive testing and treatment reigimes means that there’s a real possibility of getting close to zero new HIV infections in Western countries.
- drewmassey 8y ago
  Yeah this is true. The cost of generics is so low but in the United States it remains quite expensive if you don’t have insurance.
  - metildaa 8y ago
    Even with insurance, the cost of essential drugs is too high. Our whole healthcare system consists of the care providers billing crazy, unjustifiable amounts to Insurance, followed by insurers paying out a percentage of that. Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.
    - chimeracoder 8y ago
      > Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US. It would, but Medicare would never agree to that, because it would cut off a major source of indirect revenue for them.
      - wmeredith 8y ago
        Medicare is not a decision making body. What are you talking about?
drewmassey 8y ago
For me the biggest surprise in the article is that there are 180,000 men in the United States on Prep. Given a back of the envelope calculation of 4.8m out gay men in America (3% of population) that means adoption is itself around 3%. Somehow I imagined truvada was more widey adopted but perhaps it is just heavily marketed on the east coast.
- metildaa 8y ago
  In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.
  - chimeracoder 8y ago
    > In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most. This is wrong on so many levels. Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts. Secondly, Gilead (the manufacturer of PrEP) pays for the copay of the drug, up to a pretty high cap which is actually hard to reach under all non-catastrophic health insurances. That means that most people in the US who are on PrEP are eligible to pay literally $0 out-of-pocket. In other words, PrEP is literally cheaper for most Americans than it is for people in other countries, because every other country charges at least a nominal fee for the drug.
    - metildaa 8y ago
      > Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts. This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising. In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.
killjoywashere 8y ago
Interesting problem we're dealing with: Truvada potentially makes it harder to identify HIV+ blood donors (as their antibody titers fall naturally over time) and raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". It is a well-known fact in their community that men having sex with men are deferred from being blood donors for 12 months from last male intercourse, and there is at least a vocal minority in the community which feels this is unjust. Presently, there is no approved question for the donor questionnairre along the lines of "Are you using Truvada?" but it is a hotly debated topic among blood bankers.
- dmix 8y ago
  Is there any centralized ruling for this in the US (and other countries) or is this up to the blood banks. I'd imagine they'd face liability issues if they were taking blood from high risk individuals. This also applies to intravenous drug users as well (which has nothing to do with sexual orientation).
  - killjoywashere 8y ago
    Each donor center medical director is responsible for their own checklist, however, The American Association of Blood Banks (AABB) inspects blood donor centers and publishes their questionnairre. Not asking these questions will constitute a hit agaisnt your program and may jeopardize your institution's ability to seek reimbursement for services from, say, CMS. http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%20v2.0.pdf http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%2...
- esf 8y ago
  Truvada does nothing to change identification of HIV+ donors. Truvada does not change response to HIV tests, an HIV+ person taking Truvada as part of treatment does not stop testing positive for HIV antibodies. Nothing changes from the existing blood donation situation due to Truvada.
  - killjoywashere 8y ago
dawhizkid 8y ago
And yet STD rates are skyrocketing in the US. I take Truvada but it’s used as an excuse in the gay commmunity to engage in unprotected sex. If anything the availability of Truvada is probably a leading cause of why STD rates in the gay community are increasing.
- JumpCrisscross 8y ago
  > STD rates are skyrocketing in the US Source? (If frequencies of curable STDs are rising while those of incurable ones are falling, that would be a good trade.)
  - dawhizkid 8y ago
    Edit: common STDs that are treated by antibiotics are becoming drug resistant like anything can be that is treated with antibiotics. Point is don’t think because you can take an antibiotic and make syphilis go away now that you won’t encounter a drug resistant strain now or in the very near future! https://www.nbcnews.com/news/amp/ncna642161 https://www.nbcnews.com/news/amp/ncna642161 Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, genital herpes, etc. The recent year over year increase in STD rates in the US has been very well documented. https://www.nbcnews.com/news/amp/ncna904311 https://www.nbcnews.com/news/amp/ncna904311
    - dimgl 8y ago
      What are you talking about? There's cures for literally every single one of those diseases you mentioned.
      - dawhizkid 8y ago
        Antibiotics aren’t going to work forever on new strains of common STDs. Already seeing rise in drug resistant strains. https://www.nbcnews.com/news/amp/ncna642161 https://www.nbcnews.com/news/amp/ncna642161
    - denzil_correa 8y ago
denzil_correa 8y ago
Since April 1 2018, PrEP is subsidised by Australia under the Pharmaceutical Benefits Scheme (PBS). Thus, it costs $39.5 per script ($6.40 concessional rate) [0, 1]. Earlier, it could cost as high as $10,000 a year [2]. [0] https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-be-added-to-the-PBS https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-b... [1] https://www.healthdirect.gov.au/pharmaceutical-benefits-scheme-pbs https://www.healthdirect.gov.au/pharmaceutical-benefits-sche... [2] https://www.theguardian.com/australia-news/2018/feb/08/hiv-prevention-drug-prep-likely-to-be-approved-for-federal-subsidy https://www.theguardian.com/australia-news/2018/feb/08/hiv-p...
tomatocracy 8y ago
From what I've read previously, this isn't a surprise - PrEP is expected to make a huge impact where it's available and this study sounds like it could be very influential in getting it made available elsewhere which is, I think, its real value - the public health effect rather than the individual-level effect. The article linked below also details some of the pitfalls campaigners had to overcome to get it funded on the NHS in the UK - the biggest hurdle was not convincing people of effectiveness but that there was a need in the first place - as safer sex is much cheaper but in practice just doesn't always happen and we're probably at, or close to, the limit of what education can achieve now. https://www.bbc.co.uk/news/stories-44606711 https://www.bbc.co.uk/news/stories-44606711
jnaina 8y ago
Honest question. The generics of Truvada are available in India for around USD$30 a bottle from a number of local Indian Pharma companies including Cipla. It would still be cheaper for Americans to travel to India on a budget flight and buy back a year's supply of these generics. Wouldn't US immigration allow importation of small amounts of medicine for personnel usage if you have a doctor's prescription? https://dir.indiamart.com/search.mp?ss=tenvir-EM https://dir.indiamart.com/search.mp?ss=tenvir-EM
- adventured 8y ago
  There's a 50 dose limit, set by the Customs and Border Protection Agency when bringing drugs back into the US, without a US prescription. There are some exemptions for bringing prescriptions in from Canada and Mexico. The FDA has its own rules, set at a three month supply, requiring a prescription, and the drug must be legal in the US. You'll see conflicting reports on whether you can get through customs with a three month prescription. For example here, from the FDA: "Travel with no more than you need for your personal use during your stay. A rule of thumb: Bring no more than a 90-day supply of medication." https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.htm https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.h... Does that apply only to foreigners, to US citizens, both? Who knows, their own information across agencies seems conflicting and confused. They're probably all unsure of which agency actually has final authority at this point, and or they each probably think their agency does. That said, every year millions of Americans bring in illegal prescriptions regardless. If you're desperate enough and the savings is high enough, why not try it within reason (stopping short of some large cache that gets you tagged for smuggling that is).

130 points by startupflix 8y ago

Corroboration from a more reliable news source than Bloomberg: https://m.indiatimes.com/health/buzz/this-blue-pill-has-been-proving-to-halt-the-spread-hiv-in-its-tracks-355092.html https://m.indiatimes.com/health/buzz/this-blue-pill-has-been...

Retric 8y ago

Graph seems to be comparing 6 months of 2018 with full years before that which would vastly overstate the decline.

akovaski 8y ago
This is misleading to the point that I would consider this lying to the audience. It's just wrong to convey the data in this way. The note below the graph does not make this OK. If anybody is interested in the actual data, I think the data is pulled from "NSW HIV Surveillance Data Reports": https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data.aspx https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data...
- thanatosmin 8y ago
  Yep, look at Figure 1: https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018-nsw-hiv-data-report.pdf https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018... The trend seems to be downward, but it's more like ~10% in the past couple years than a step change.
jliptzin 8y ago
Thanks, I overlooked that myself, and is definitely misleading.

DenisM 8y ago

Developed by Gilead, the same company that created the Hep-C cure Sovaldi. Some kick-ass work there.

tpetry 8y ago
Have been googling Solvadi. Wow, curable hepatitis c is a big achievemt. But it‘s insanely expensive. It has to be taken daily for at least 12 weeks, with each pill costing 400€! The chance of curing is at 90%.
- DenisM 8y ago
  It was $100k per course at the time of introduction in the US, which resulted in a lot of hate. But it is a miracle. A close relative of mine was cured, and it had a profound effect on her quality of life. Gilead has very different prices in different regions, we sourced from a place that was much cheaper.
  - exhilaration 8y ago
    Since your relative is cured, I don't think there's any harm in telling us what country you sourced the drug from.
    - DenisM 8y ago
      India.
- tptacek 8y ago
  That sounds pretty inexpensive. It looks like the previous standard of care cost $10-15,000 and wasn't generally curative. Meanwhile, the long-term cost of a progressing hep-c infection is quite high.
  - metildaa 8y ago
    In the context of a decietful medical system that bills pie in the sky amounts for rendering basic care, a $100k cure for Hepatitis C might seem reasonable. But those who need it most are dying due to this pricing scam, which is standard for our healthcare in the US.

matthewmacleod 8y ago

The effectiveness of the tenofovir and emtricitabine combination is hard to overstate. Other studies show almost 100% prevention of infection; to my knowledge there have only been two recorded infections in people who were reliably taking PReP, both of which were due to unusual, rare mutations. This sort of thing is a step change for vulnerable populations; hopefully it ends up being widely accessible. The combination of this and aggressive testing and treatment reigimes means that there’s a real possibility of getting close to zero new HIV infections in Western countries.

drewmassey 8y ago
Yeah this is true. The cost of generics is so low but in the United States it remains quite expensive if you don’t have insurance.
- metildaa 8y ago
  Even with insurance, the cost of essential drugs is too high. Our whole healthcare system consists of the care providers billing crazy, unjustifiable amounts to Insurance, followed by insurers paying out a percentage of that. Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.
  - chimeracoder 8y ago
    > Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US. It would, but Medicare would never agree to that, because it would cut off a major source of indirect revenue for them.
    - wmeredith 8y ago
      Medicare is not a decision making body. What are you talking about?

drewmassey 8y ago

For me the biggest surprise in the article is that there are 180,000 men in the United States on Prep. Given a back of the envelope calculation of 4.8m out gay men in America (3% of population) that means adoption is itself around 3%. Somehow I imagined truvada was more widey adopted but perhaps it is just heavily marketed on the east coast.

metildaa 8y ago
In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.
- chimeracoder 8y ago
  > In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most. This is wrong on so many levels. Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts. Secondly, Gilead (the manufacturer of PrEP) pays for the copay of the drug, up to a pretty high cap which is actually hard to reach under all non-catastrophic health insurances. That means that most people in the US who are on PrEP are eligible to pay literally $0 out-of-pocket. In other words, PrEP is literally cheaper for most Americans than it is for people in other countries, because every other country charges at least a nominal fee for the drug.
  - metildaa 8y ago
    > Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts. This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising. In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.

killjoywashere 8y ago

Interesting problem we're dealing with: Truvada potentially makes it harder to identify HIV+ blood donors (as their antibody titers fall naturally over time) and raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". It is a well-known fact in their community that men having sex with men are deferred from being blood donors for 12 months from last male intercourse, and there is at least a vocal minority in the community which feels this is unjust. Presently, there is no approved question for the donor questionnairre along the lines of "Are you using Truvada?" but it is a hotly debated topic among blood bankers.

dmix 8y ago
Is there any centralized ruling for this in the US (and other countries) or is this up to the blood banks. I'd imagine they'd face liability issues if they were taking blood from high risk individuals. This also applies to intravenous drug users as well (which has nothing to do with sexual orientation).
- killjoywashere 8y ago
  Each donor center medical director is responsible for their own checklist, however, The American Association of Blood Banks (AABB) inspects blood donor centers and publishes their questionnairre. Not asking these questions will constitute a hit agaisnt your program and may jeopardize your institution's ability to seek reimbursement for services from, say, CMS. http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%20v2.0.pdf http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%2...
esf 8y ago
Truvada does nothing to change identification of HIV+ donors. Truvada does not change response to HIV tests, an HIV+ person taking Truvada as part of treatment does not stop testing positive for HIV antibodies. Nothing changes from the existing blood donation situation due to Truvada.
- killjoywashere 8y ago

dawhizkid 8y ago

And yet STD rates are skyrocketing in the US. I take Truvada but it’s used as an excuse in the gay commmunity to engage in unprotected sex. If anything the availability of Truvada is probably a leading cause of why STD rates in the gay community are increasing.

JumpCrisscross 8y ago
> STD rates are skyrocketing in the US Source? (If frequencies of curable STDs are rising while those of incurable ones are falling, that would be a good trade.)
- dawhizkid 8y ago
  Edit: common STDs that are treated by antibiotics are becoming drug resistant like anything can be that is treated with antibiotics. Point is don’t think because you can take an antibiotic and make syphilis go away now that you won’t encounter a drug resistant strain now or in the very near future! https://www.nbcnews.com/news/amp/ncna642161 https://www.nbcnews.com/news/amp/ncna642161 Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, genital herpes, etc. The recent year over year increase in STD rates in the US has been very well documented. https://www.nbcnews.com/news/amp/ncna904311 https://www.nbcnews.com/news/amp/ncna904311
  - dimgl 8y ago
    What are you talking about? There's cures for literally every single one of those diseases you mentioned.
    - dawhizkid 8y ago
      Antibiotics aren’t going to work forever on new strains of common STDs. Already seeing rise in drug resistant strains. https://www.nbcnews.com/news/amp/ncna642161 https://www.nbcnews.com/news/amp/ncna642161
  - denzil_correa 8y ago

denzil_correa 8y ago

Since April 1 2018, PrEP is subsidised by Australia under the Pharmaceutical Benefits Scheme (PBS). Thus, it costs $39.5 per script ($6.40 concessional rate) [0, 1]. Earlier, it could cost as high as $10,000 a year [2]. [0] https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-be-added-to-the-PBS https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-b... [1] https://www.healthdirect.gov.au/pharmaceutical-benefits-scheme-pbs https://www.healthdirect.gov.au/pharmaceutical-benefits-sche... [2] https://www.theguardian.com/australia-news/2018/feb/08/hiv-prevention-drug-prep-likely-to-be-approved-for-federal-subsidy https://www.theguardian.com/australia-news/2018/feb/08/hiv-p...

tomatocracy 8y ago

From what I've read previously, this isn't a surprise - PrEP is expected to make a huge impact where it's available and this study sounds like it could be very influential in getting it made available elsewhere which is, I think, its real value - the public health effect rather than the individual-level effect. The article linked below also details some of the pitfalls campaigners had to overcome to get it funded on the NHS in the UK - the biggest hurdle was not convincing people of effectiveness but that there was a need in the first place - as safer sex is much cheaper but in practice just doesn't always happen and we're probably at, or close to, the limit of what education can achieve now. https://www.bbc.co.uk/news/stories-44606711 https://www.bbc.co.uk/news/stories-44606711

jnaina 8y ago

Honest question. The generics of Truvada are available in India for around USD$30 a bottle from a number of local Indian Pharma companies including Cipla. It would still be cheaper for Americans to travel to India on a budget flight and buy back a year's supply of these generics. Wouldn't US immigration allow importation of small amounts of medicine for personnel usage if you have a doctor's prescription? https://dir.indiamart.com/search.mp?ss=tenvir-EM https://dir.indiamart.com/search.mp?ss=tenvir-EM

adventured 8y ago
There's a 50 dose limit, set by the Customs and Border Protection Agency when bringing drugs back into the US, without a US prescription. There are some exemptions for bringing prescriptions in from Canada and Mexico. The FDA has its own rules, set at a three month supply, requiring a prescription, and the drug must be legal in the US. You'll see conflicting reports on whether you can get through customs with a three month prescription. For example here, from the FDA: "Travel with no more than you need for your personal use during your stay. A rule of thumb: Bring no more than a 90-day supply of medication." https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.htm https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.h... Does that apply only to foreigners, to US citizens, both? Who knows, their own information across agencies seems conflicting and confused. They're probably all unsure of which agency actually has final authority at this point, and or they each probably think their agency does. That said, every year millions of Americans bring in illegal prescriptions regardless. If you're desperate enough and the savings is high enough, why not try it within reason (stopping short of some large cache that gets you tagged for smuggling that is).