5 ms·

The effectiveness of the tenofovir and emtricitabine combination is hard to overstate. Other studies show almost 100% prevention of infection; to my knowledge t

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?
      - chimeracoder 8y ago
        > Medicare is not a decision making body. What are you talking about? CMS absolutely is a "decision making body", with direct authority over a whole number of matters. But even beyond its office authority granted by Congress, Medicare (both the people who run it and the people who generally support it) are incredibly influential as well, and they would use that influence to block any policy that would affect Medicare so negatively (even if it would be good for the public at large)
- chimeracoder 8y ago
  > but in the United States it remains quite expensive if you don’t have insurance. Not really - Gilead provides assistance programs for people who have private insurance, for people on public insurance, and for people who are uninsured (there are three separate assistance programs). The plan for people who have private insurance is the best (you end up paying $0/year for PrEP), and the plan for people who are uninsured is pretty good (not $0/year, but still pretty affordable).
  - drewmassey 8y ago
    Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.
    - chimeracoder 8y ago
      > Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us. The sticker price is meaningless. Because of the assistance programs, nobody needs to pay it, whether you're on private insurance or uninsured.
      - aerotwelve 8y ago
        Serious question: what's the point of the sticker price then? Surely someone must be paying it, right? If not, why not lower it for -- at a minimum -- a PR boost?
        brazzledazzle 8y ago
        It might be used as a starting point for negotiation with private insurers.
        barry-cotter 8y ago
        The sticker price is negotiating leverage for use against organisations with money, the insurance companies and Medicaid and Medicare. They don’t pay the sticker price either but they come much closer because they’re price insensitive. All costs get passed on, on average to the actuarial customer.
chimeracoder 8y ago
> 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. The number is actually six, but given the number of people who've been taking PrEP since it was FDA-approved in 2012, that's still an impressive number. The reason emtricitabine and tenofovir disoproxil fumarate work well together is because the primary known mutation that makes HIV resistant to the latter also increases its susceptibility to the former. There's a analogous situation in reverse with the primary mutation that provides resistance to emtricitabine. PrEP is effective because strains of HIV that are resistant to both drugs are very rare, and also because most people who have resistant strains of HIV are on ARV treatment, which suppresses the viral load to the point where they cannot infect anyone else anyway (even without PrEP).
vecter 8y ago
What is the possibility of more widespread drug resistance as the HIV strains that exhibit immunity are selected for?
- peterlk 8y ago
  Can someone provide a compelling argument for why we should not keep charging ahead given this risk? It seems to me that drug-resistant HIV would maintain the status quo, but I don't really know anything about the landscape of drugs/resistance in HIV
  - AllegedAlec 8y ago
    > I don't really know anything about the landscape of drugs/resistance in HIV HIV is a retrovirus with an absurdly high mutation rate (4 × 10−3 per base per cell, Cuevas, J. et al, 2015). In comparison: the mutation rate of influenza is about one or two orders of magnitude lower. This means that it is incredibly quick to adapt to any changes.
jsperx 8y ago
There have now been six: https://www.out.com/news-opinion/2018/10/09/sixth-case-man-contracting-hiv-while-adhering-prep-confirmed https://www.out.com/news-opinion/2018/10/09/sixth-case-man-c...

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?
    - chimeracoder 8y ago
      > Medicare is not a decision making body. What are you talking about? CMS absolutely is a "decision making body", with direct authority over a whole number of matters. But even beyond its office authority granted by Congress, Medicare (both the people who run it and the people who generally support it) are incredibly influential as well, and they would use that influence to block any policy that would affect Medicare so negatively (even if it would be good for the public at large)
chimeracoder 8y ago
> but in the United States it remains quite expensive if you don’t have insurance. Not really - Gilead provides assistance programs for people who have private insurance, for people on public insurance, and for people who are uninsured (there are three separate assistance programs). The plan for people who have private insurance is the best (you end up paying $0/year for PrEP), and the plan for people who are uninsured is pretty good (not $0/year, but still pretty affordable).
- drewmassey 8y ago
  Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.
  - chimeracoder 8y ago
    > Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us. The sticker price is meaningless. Because of the assistance programs, nobody needs to pay it, whether you're on private insurance or uninsured.
    - aerotwelve 8y ago
      Serious question: what's the point of the sticker price then? Surely someone must be paying it, right? If not, why not lower it for -- at a minimum -- a PR boost?
      - brazzledazzle 8y ago
        It might be used as a starting point for negotiation with private insurers.
      - barry-cotter 8y ago
        The sticker price is negotiating leverage for use against organisations with money, the insurance companies and Medicaid and Medicare. They don’t pay the sticker price either but they come much closer because they’re price insensitive. All costs get passed on, on average to the actuarial customer.

chimeracoder 8y ago

> 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. The number is actually six, but given the number of people who've been taking PrEP since it was FDA-approved in 2012, that's still an impressive number. The reason emtricitabine and tenofovir disoproxil fumarate work well together is because the primary known mutation that makes HIV resistant to the latter also increases its susceptibility to the former. There's a analogous situation in reverse with the primary mutation that provides resistance to emtricitabine. PrEP is effective because strains of HIV that are resistant to both drugs are very rare, and also because most people who have resistant strains of HIV are on ARV treatment, which suppresses the viral load to the point where they cannot infect anyone else anyway (even without PrEP).

vecter 8y ago

What is the possibility of more widespread drug resistance as the HIV strains that exhibit immunity are selected for?

peterlk 8y ago
Can someone provide a compelling argument for why we should not keep charging ahead given this risk? It seems to me that drug-resistant HIV would maintain the status quo, but I don't really know anything about the landscape of drugs/resistance in HIV
- AllegedAlec 8y ago
  > I don't really know anything about the landscape of drugs/resistance in HIV HIV is a retrovirus with an absurdly high mutation rate (4 × 10−3 per base per cell, Cuevas, J. et al, 2015). In comparison: the mutation rate of influenza is about one or two orders of magnitude lower. This means that it is incredibly quick to adapt to any changes.

jsperx 8y ago

There have now been six: https://www.out.com/news-opinion/2018/10/09/sixth-case-man-contracting-hiv-while-adhering-prep-confirmed https://www.out.com/news-opinion/2018/10/09/sixth-case-man-c...