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Huge study finds drugs stop HIV transmission
- torstenvl 7y agoThrough the '90s and even into the very early 21st century, doctors would hold off before starting antiretrovirals. After acute HIV infection (which often causes flu-like symptoms, known as sero-conversion sickness), the body naturally suppresses the HIV infection to manageable levels. So the standard advice was not to medicate yet. Of course, that meant that most HIV-infected individuals were still contagious. Their viral levels were low, but they weren't so low as to prevent transmission. Combined with a social stigma that kept people from getting tested, this medical treatment philosophy is a major part of why HIV became as prevalent as it did. I understand why - early drugs like AZT were even harder on the patient's liver than modern drugs. But at best that seems myopic; at worst, it was negligent from a public health perspective. It is probably a bad thing that, at least in the U.S., we separate the medical field from the public health field so arbitrarily. Maybe -- hopefully -- this development in HIV treatment and the evolution of antibiotic-resistant bacterial infections will make us rethink this dichotomy.
- fucking_tragedy 7y ago> I understand why - early drugs like AZT were even harder on the patient's liver than modern drugs. But at best that seems myopic; at worst, it was negligent from a public health perspective. Today we have drugs that prevent the initial infection of HIV, they're dubbed pre-exposure prophylaxis drugs. The only drug approved for this use in the US is a formulation called Truvada. It can cause bone and kidney damage, and is contraindicated in patients with renal impairment. Gilead, the drug's manufacturer, has risen the price of the drug from $6 to $1600 a month. Other formulations, such as Descovy, have less of an impact on the renal system. Gilead has been sued for allegedly withholding the drug in order to time its introduction with the expiration of Truvada's patent in 2021[1]. Truvada's pricing, side-effects, and contraindications keep it from reaching many of those who are at risk of becoming infected with and transmitting HIV. Alleged patent timing is preventing the release of safer drugs that are just as effective. While we've come very far, we still haven't escaped negligence from a public health perspective. [1] https://www.marketwatch.com/press-release/mass-tort-alleges-gilead-sciences-inc-withheld-safer-drugs-from-hivaids-patients-manipulated-patent-timing-for-profit-announces-jenner-law-2019-04-19 https://www.marketwatch.com/press-release/mass-tort-alleges-...
- adventured 7y ago> Gilead, the drug's manufacturer, has risen the price of the drug from $6 to $1600 a month. Your premise is correct, that the elevated price is harming the cause of fighting HIV. Your cost figures are incorrect however. In Canada, even their health system has approved generic Truvada at wholesale for $400 per month (Truvada is twice that in Canada). Your $6 figure is plain wrong. That's the lowest wholesale cost anywhere in the developed world at any point in the drug's history. That's not the cost that it started out at in the US. It was about $1,150 (average reimbursement rate) in 2009. Truvada brought in $567 million in sales in just 2005 alone, they didn't accomplish that at $6 per month in the US. Gilead further increased the wholesale price by 45% over six years, from 2012 to 2018.
- MrEldritch 7y agoBy "alleged patent timing", do you mean the patents are only alleged, or that the expiration dates of those patents are only alleged? Because either one of those statements is ... confusing to me.
- fucking_tragedy 7y agoIf you read the citation I gave in the OP, Gilead is alleged to have withheld the introduction of Descovy for PrEP until their patent on Truvada expires.
- joshlittle 7y agoU=U is fantastic science; though it hasn’t been enough to totally remove the stigma of HIV, even in San Francisco. I believe it comes from not enough dissemination of information regarding the nonexistent risk of contracting HIV from an undetectable partner. I’m also concerned that by focusing on HIV as a manageable, chronic condition - we discount the need for a cure. A dystopian future possibility that’s come through my head is the cure is a century away despite progress, and U=U doesn’t do enough to remove the stigma faced today regardless how much the public is informed of the science. I believe that a cure is required to truly remove the stigma of HIV. I can scream “I am undetectable” from the rooftops and what that entails It’s never going to matter to the people that find creative ways to cancel plans, get out of dates, etc. when I disclose my status as HIV+ to them. I’m at least thankful for the people that tell me it makes them uncomfortable to consider kissing or any sexual contact - even with this knowledge. And even with pre exposure prophylaxis / PrEP.
- xattt 7y agoTo be nitpicky, but if there is a vaccine in the future, antigen testing will likely show that you are HIV antibody positive.
- hughes 7y agoI think in addition to the stigma, there will always be a matter of trust. If someone claims to be undetectable, at what point do you believe them? Right away, no questions asked? What level of trust is required to be sure they ever were, or still are, undetectable? Has the source of their medicine changed? How secure is their access to it? Any financial stresses or other factors that would affect their medicine's availability? It's a lot to ask of someone - on both sides. How do you think someone could approach this in a way that preserves your humanity and your privacy?
- lazzlazzlazz 7y agoA very similar kind of trust is required in general for any sexual contact: if someone claims to have been tested, at what point do you believe them? Has that changed? How reliable is their access to testing? Could they have contracted something recently, and it is simply incubating with no symptoms? It's not exactly the same, but it's not entirely different.
- bichiliad 7y agoIt seems like a really scary gamble to have unprotected sex with someone who is HIV-positive for a research study, and I was wondering how the study found such couples. The paper mentions that they identified couples with one HIV-positive partner, and then followed up with them to see if they reported condomless sex.
- mattkrause 7y agoRandomizing people to have sex with an HIV+ or placebo partner would bring down the IRB's wrath quite quickly. For that reason, a lot of this stuff is done observationally, where you just track people doing whatever they were going to do anyway. The data is often not as clean as a randomized controlled trial, but it seems much more ethical. An earlier trial (HPTN 052) did actually run a RCT, but the treatment strategy was randomized, not the partner. It worked so well that the trial was actually stopped early and everyone was offered antivirals. Cohen et al. (2011) reported the results here: https://www.nejm.org/doi/10.1056/NEJMoa1105243?url_ver=Z39.88-2003 https://www.nejm.org/doi/10.1056/NEJMoa1105243?url_ver=Z39.8...
- Fomite 7y agoYou can get near to an RCT with newer trial designs like stepped-wedge designs, which are way better in terms of equipoise and nearly as efficient statistically.
- mattkrause 7y agoThose are still interventional though, right? (I probably should have written observational vs. interventional instead of obs. vs RCT).
- Fomite 7y agoYep. The stepped-wedge design, for example, is one where everyone will get the intervention, but the time in which they get it is randomized.
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- gravypod 7y agoAnother amazing advancement that I didn't know much about until hearing of from a friend are PrEP treatments. In terms that I understand it's a class of drugs that can be used as a treatment for HIV that is prescribed to someone who have not contracted HIV. By taking the drug you lower your chance of contracting HIV on exposure. "Studies have shown that PrEP reduces the risk of getting HIV from sex by more than 90% when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently." [0] I found this site to be very interesting when reading up on the topic: https://prepfacts.org/prep/the-research/ https://prepfacts.org/prep/the-research/ [0] - "How well does PrEP work" https://www.cdc.gov/hiv/basics/prep.html https://www.cdc.gov/hiv/basics/prep.html
- User23 7y agoPromiscuous people are the only vector for HIV and other sexually transmitted diseases. This is a problem that was solved shortly after hydroengineering. There’s a very popular book that contains a foolproof guide to avoiding this class of diseases. No disrespect intended towards those individuals who prefer to, for whatever reason, engage in manifestly high risk activities. Although I’d rather not be taxed to pay for their abject stupidity. Sadly we live in an hedonic age and you all know what that means.
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- rincebrain 7y agoWhy should promiscuity mean that they should have to privately fund their treatment? (Not that promiscuity is the only way you can get HIV, but that's not the question I'm asking.) People have differing ideas about what acceptable and unacceptable behavior is. If we required that taxes only be collected for the set of behaviors everyone agreed on, we'd have no taxes, and no government. Even if we agreed that promiscuous people should not receive public medical treatment (which is not a position I hold), would you suggest condemning people who contracted this through no act of their own as well? Parents can give it to their children, and there are nonsexual ways you can end up with bodily fluid transmission. Assuming you're describing the book I think you are, there are a number of editions of said book in which one of the protagonists shows mercy toward the sick and ostracized people.
- qazpot 7y ago> would you suggest condemning people who contracted this through no act of their own as well? No, but these cases can be identified. For ex - children or people with unfaithful spouses. A majority of HIV infections are due to unprotected sex. > there are nonsexual ways you can end up with bodily fluid transmission. Please do tell use about these nonsexual ways. Cause I was under impression that normal contact during daily life carries no risk.
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- eecc 7y agoThe HIV plague is wiping out the productive age group in Africa. I sympathize for western patients and am glad the condition is treatable for them... but we really should figure out how to deploy treatments to African residents, implementing the logistics, delivering the education, removing the graft and corruption that keeps killing hundreds of thousands.
- krageon 7y agoWe can do both. There is absolutely no reason why a breakthrough has to be suffixed with "well that's great, but it would be much greater to look at this demographic!". These are all people, and they all deserve treatment equally.
- neuronic 7y agoYou are right. So we must look at why this isn't happening. From a moral perspective it should. Resources and capability are available but the ones at the steering wheel are not willing to allow them to be used. Otherwise it would be done, right? Does anyone have any explanation for this? How popular would this action be with the people of North America/Europe/Asia? Would it even make a dent in terms of budget when compared to typical foreign aid payments for example? The Chinese are heavily investing in Africa to gain influence and resources, the Europeans ship off billions of Euros in goods and cash for aid, the US is also buying influence with aid all over Africa. Is it simply not paying off? There is no short term political or economic benefit here? Is that it?
- cblades 7y ago>Resources and capability are available I think that's something you have to support. Certainly it is possible, but what else are you putting off or de-prioritizing to do it? I certainly agree that we should aim to make the most impactful improvements in the most people's lives, I just don't quite know how a global society or even individual countries go about a reasonable prioritization process.
- burnte 7y ago
- jl6 7y agoJust thinking theoretically... if 100% of HIV positive individuals became untransmitters, would HIV die out with that generation?
- orcasauce 7y agoConsider what we did to smallpox. It's gone, but not really.
- boyband6666 7y agoAlso the headline is massively misleading - almost immediately they point out that many people don't know their status.
- thefounder 7y agoWhat "fully suppressed" means and for how long? I don't think many would risk if were told their (potential)partner was tested at the beginning of the month and the virus seamed "fully suppressed". Why take the risk?
- sAbakumoff 7y agoin mice? https://twitter.com/justsaysinmice https://twitter.com/justsaysinmice
- Circuits 7y agoWait a second, so 15 men who were participating in an HIV study with their partners managed to contract HIV from someone else, during the study, who wasn't their partner??? ?
- MrEldritch 7y agoNo, you dumbass, in people. Jesus Christ, read the article before firing off a snarky comment.
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