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FDA approves first monthly injectable to treat HIV infection
- outlace 6y agoGreat news. There are definitely a number of people out there who, in part due to social circumstances have difficulty taking meds daily and this will likely help a good proportion of them.
- deleted 6y ago[deleted]
- transfire 6y agoWhile good news, it is unfortunate to know we will probably never see an actual cure. Capitalized medicine disincentivizes cures. That's why we see so many symptom treatments and vaccines -- they are far more profitable, by multiple orders of magnitude.
- Merman_Mike 6y agoInstead of downvotes, I'm curious what evidence there is on either side of this claim.
- grawprog 6y agohttps://www.ncbi.nlm.nih.gov/books/NBK217902/ https://www.ncbi.nlm.nih.gov/books/NBK217902/ https://fee.org/articles/curing-diseases-is-sustainable-government-in-healthcare-is-not/ https://fee.org/articles/curing-diseases-is-sustainable-gove... https://www.bmj.com/content/363/bmj.k4351 https://www.bmj.com/content/363/bmj.k4351 https://theconversation.com/amp/how-pharmaceutical-companies-profit-from-drugs-for-rare-diseases-65266 https://theconversation.com/amp/how-pharmaceutical-companies... https://yaledailynews.com/blog/2017/02/09/lewis-the-need-for-a-cure-incentive/ https://yaledailynews.com/blog/2017/02/09/lewis-the-need-for... https://www.medpagetoday.com/blogs/revolutionandrevelation/72407 https://www.medpagetoday.com/blogs/revolutionandrevelation/7... https://pnhp.org/news/eliminate-the-profit-motive-in-health-care/ https://pnhp.org/news/eliminate-the-profit-motive-in-health-...
- Merman_Mike 6y agoMany of these seem to support GP's comment.
- grawprog 6y agoI don't really understand the downvotes and reactions of the other commenters to the gp's post. There's a whole bunch of studies showing there's less incentive to find cures opposed to ongoing treatments under for profit health systems. On a website where products as a service are discussed regularly i'm confused as to how the parallels between that and profit driven 'healthcare as a service' are ignored or looked at with hostility.
- Merman_Mike 6y ago.
- dang 6y agoIt was a generic ideological flamewar tangent. That includes several good reasons for downvoting. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- Merman_Mike 6y ago. [just gonna stop commenting on this site]
- pvg 6y agoA comment that spawns a lengthy subthread of meta trying to parse out what the commenter actually meant, why precisely they are being downvoted, etc, is bad. As is the subthread of meta.
- dang 6y ago> Is the flamewar tangent part of this the comment on capitalism or "Capitalized medicine"? Doesn't really seem flamie to me but obviously others disagree. The problem is the generic ideological tangent. You can perhaps (maybe!) imagine a substantive article and thread on the economics of cures vs. treatments. But that would require different initial conditions—primarily an interesting, informative article that brought lots of relevant information. Relevant information is flame retardant. The situation is different when the topic is "FDA approves first monthly injectable to treat HIV infection" and the comment is swerving generically into "capitalized medicine". Generic tangents, especially when the impetus is snarky or unsubstantive, make threads reliable less interesting, and generic ideological tangents almost always turn into flamewars. The reason is that there's very little specific information to discuss—that's the meaning of "generic". Off-topic tangents can be great when they're unpredictable and curious, but generic tangents are the opposite of that. They're more like getting sucked into the gravitational field of a much larger body, if not a black hole, that pulls all nearby topics toward itself and renders them all the same. Avoiding repetition is the biggest problem that a forum like HN—dedicated to curiosity—actually has, so it's a big deal: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&sort=byDate&type=comment&query=curiosity%20repetition%20by:dang https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so.... I hope this helps explain things a bit. There are lots of past explanations at https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sort=byDate&type=comment&query=generic%20discussion%20by:dang https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor... also, but you'll unfortunately—and ironically—have to wade through some generic repetition to find the interesting bits.
- dougmwne 6y agoI am sure there is some evidence on both sides, but at the end of the day, people get into medicine and medical research to heal people, not keep them sick. The USA does not have the only medical system in the world and many countries run their systems with the goal of controlling costs, not increasing them. I don't think this kind of pessimistic conspiracy thinking adds to the conversation.
- incrudible 6y agoIf there's more money to be made from keeping people sick than outright curing them, that logically is a disincentive from curing them. It's not conspiracy thinking to look at the incentive structures within systems to predict possible negative outcomes. Of course, there's a moral incentive to not keep people sick, but history shows that we can not rely on people acting morally. The pessimism is justified. If we expect companies to provide cures over treatments, we at least must allow them to profit as much or more from a cure as they would from a treatment.
- jjcon 6y ago> we at least must allow them to profit as much or more from a cure as they would from a treatment I think that’s where you go wrong. There are huge profit incentives for a cure. If a biotech company comes up with a cure they will instantly have the business of every afflicted person on the planet. The market for that and price they can charge will be way larger than a slightly different treatment. Beyond that, there are labs all over the world funded by public dollars to research avenues to a cure, it’s just way more complicated than effective treatment.
- deleted 6y ago[deleted]
- call_me_dana 6y agoThere are indeed huge profit incentives for a cure. There are even larger profits to be had from a monthly treatment that the patient has to take for the rest of their lives. Are you saying people that aren’t taking a monthly biologic injection for example will start coming out of the woodwork for a cure when normally they wouldn’t seek treatment for their malady?
- whimsicalism 6y agoWell not sure if it is "evidence", but in terms of marginal preventing people in the US from getting HIV, lowering the cost of Truvada from $2,000 out of pocket and publicizing it would likely have a much larger impact than this once a month shot.
- eli 6y agoI'm not sure every claim is worthy of debate. Setting aside all the private investment and philanthropy dollars going towards a cure, governments spend billions annually on HIV research.
- call_me_dana 6y agoYes, they spend billions on developing the exact types of treatments that this article is about. Their business model depends on maximizing revenue so any treatment cannot cure the patient and it cannot kill the patient. Sad, but true.
- eli 6y agoThe business model of the NIH and the UN does not depend on maximizing revenue
- icegreentea2 6y agoThe claim logically holds together. There is even evidence on its side. But one reason for the downvotes may be that it might be too narrow-minded. For one thing, it completely neglects to consider the relative difficulty of treating symptoms versus being fully curative. Secondly, it half undermines itself by lumping vaccines into the same bucket as symptomatic treatment. Clearly the economic incentives for vaccine, versus symptom management, versus cure depends on the disease being treated. Finally, while it carefully uses the word "incentive" instead of talking in black and whites, it doesn't explain why "big pharma" makes cures at all. A lot of the the supporting material for "pharma makes more money on symptom treatment" references Gilead's experience with Hep C. But the economics of how that drug would have worked was clear as day before Gilead spent resources of it. So why would Gilead have gone to market with a cure at all?
- TimPC 6y agoThe claim doesn't logically hold together: it assumes a monopoly in medicine. It might not be profitable for the company with a treatment regimen to develop a cure. But for the company without the treatment regiment to develop a cure and take away all of a competitor's business and capture a significant part of it as their own? That's extremely profitable. You can charge far more for a cure than for a regular preventative treatment (per dose) so margins are far higher even if volume over time is lower. Suffice it to say cures are sufficiently profitable to enough of the actors in the system that they are worth exploring. And there is evidence of cures being researched successfully as referenced in the comment above. Also, I don't think all pharma companies are perfectly 'rational' actors in this sense. They are composed of people who got into medicine with the interest to help people, and those people know both cures and vaccines help more than just symptom mitigation. The motivation of the actors in the system to do good leads to even more research of cures and vaccines than the non-zero amount that is sufficiently incentivized (even if cures are less profitable than symptom mitigations).
- JumpCrisscross 6y ago> I'm curious what evidence there is on either side of this claim Looking at the list of the most deadly non-tropical infectious diseases [1], most can be vaccinated against and/or cured. The standouts remain lower respiratory infections, e.g. influenza, and HIV/AIDS. When confronted with a novel coronavirus, it took a few months for the world's medical systems to devise various treatments and a vaccine. Neither of those are recurring revenue streams. Most damning to this conspiracy theory is the recent Hep C cure. That's a real disease. It was profitable to treat. But it's more profitable to cure. Those incentives remain elsewhere. A cure for HIV is worth billions. Dealing with mortality and sickness is difficult. It's more comforting to some to imagine an evil cabal holding back medicine, and I don't need to take that from them. But if you're entertaining these thoughts as anything more than a coping mechanism, the last half century--or even decade--of progress in curing, not treating, curing a variety of medical issues has been under-reported (lots of niche illnesses) and breathtaking. [1] https://en.wikipedia.org/wiki/Infection https://en.wikipedia.org/wiki/Infection
- throwawaygal7 6y agoI came here to post about the Hep C cure. You did a great job. Only thing I would embellish on is that, much like software - when something is wrong its easier to treat the symptoms than to fix the problem a lot of the times. So it's really no wonder alot of treatments are amelioration rather than cures. I recently did a major refactor at work to fix database and caching problems in our backend. It took months but only yielded 50% scaling improvements. Past teams just kept stacking shit and adding hardware and we can all understand why.
- dang 6y agoCould you please stop creating accounts for every few comments you post? We ban accounts that do that. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html. You needn't use your real name, of course, but for HN to be a community, users need some identity for other users to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comment&storyText=false&prefix&page=0&query=community%20identity%20by:dang https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
- samatman 6y agoComing up with a cure for HIV infection would be an easy Nobel Prize in medicine. That's a pretty powerful motive, historically. If you want to argue that it doesn't apply here, the burden, I'm afraid, is on you, not us.
- throwaway292893 6y agoYeah, that's why the US leads the world in healthcare research.
- deleted 6y ago[deleted]
- dang 6y ago"Don't be snarky." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- deleted 6y ago[deleted]
- TheAdamAndChe 6y agoThere are plenty of researchers who would find a cure if it was possible. HIV integrates into the DNA of the cells it infects, and is virtually impossible to detect and remove completely.
- dang 6y ago"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html Especially not generic ideological tangents: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sort=byDate&type=comment&query=generic%20ideolog%20by:dang https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...
- dougmwne 6y agoI have always heard that Truvada (prep) was extremely effective at preventing HIV infection. These new injectables are reported by the article to be 89% and 66% more effective at preventing transmission. What is this based on? Was I misinformed about Truvada's effectiveness? Is this a decrease in an already very low chance of transmission? Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering? It's currently common in the gay community for sexually active, healthy people to take Truvada proactively to protect against HIV because it's understood to be even more effective than condoms. If there is a better option or if the current option is not as effective as widely believed then standard of care should change.
- whimsicalism 6y ago> Was I misinformed about Truvada's effectiveness? No, effectively used Truvada works very well. > Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering? Probably almost certainly yes or it's just a small improvement at the margin.
- cestith 6y agoI don't have stats, but Biktarvy has been advertised for PReP lately. Descovy is approved by the FDA for such use. The shot is around the same price (at list anyway) as some of the other treatments, so if it's even equally effective the convenience might win.
- vsef 6y agoBiktarvy doesn't make any sense for PrEP, Descovy is emtricitabine and tenofovir alafenamide, Biktarvy is emtricitabine and tenofovir alafenamide plus an integrase inhibitor which just adds possible additional side effects and isn't necessary.
- Grazester 6y agoThe article states, "...abotegravir – a component of Cabenuva – was 89% more effective in preventing infection among women than Truvada" That 89% when was compared to Truvada. Do healthcare workers actively take Prep or is it administered within the 72 hour period after exposure? Prep from what I understand can be hard on the body's organs and you will need to do a kidney function test every few months when on it
- afrojack123 6y agoSubscription based healthcare. lol
- cestith 6y agoIt's good to see articles on new drugs include pricing information.
- ed25519FUUU 6y ago> In 2018, for instance, there were approximately 36,400 newly infected patients living with HIV in the U.S. This number seems insane to me in the USA. Why is a well known deadly disease, with well understood transmission vectors, still spreading so prominently here?
- minikites 6y agoBecause people don't have healthcare. We've decided as a society that it's better for undesirable people (gay men, IV drug users) to die instead of paying a cent more than we absolutely must in taxes.
- bpodgursky 6y agoBecause people really, really like having risky and unsafe sex?
- damnyou 6y agoNo, that's not the reason, given that PrEP exists. The actual reason is that Truvada, like other healthcare, can be hard to get in the American system.
- deleted 6y ago[deleted]
- renewiltord 6y agoHave we considered telling people to "just stay home" and to "not have sex"? Maybe that's the trick.
- damnyou 6y agoRight. Abstinence doesn't really work in the real world, only in the spherical-cow world where humans are perfectly obedient.
- 6y ago
- jliptzin 6y ago> In 2018, for instance, there were approximately 36,400 newly infected patients living with HIV in the U.S. It's 2021, why are we only seeing 3 year old HIV infection numbers? How come I can see coronavirus infection numbers updated pretty much hourly but reporting on HIV infection rates in this country is lagging 3 years?
- ceejayoz 6y agoCOVID takes a few days to show symptoms and get diagnosed. HIV takes a lot longer. https://www.onlineathens.com/news/2017-11-28/cdc-lag-time-between-hiv-infection-and-diagnosis-getting-shorter https://www.onlineathens.com/news/2017-11-28/cdc-lag-time-be... > In their monthly Vital Signs report out Tuesday, the Centers for Disease Control and Prevention reported that the median time between infection and diagnosis with HIV was three years in 2014, about seven months shorter than in 2011. If you got HIV in 2020, chances are you don't know about it yet.
- jliptzin 6y agoI understand that, but I don't see what is so complicated about reporting # of HIV tests conducted in a certain timeframe (daily, monthly, whatever) and what portion of those tests came back positive, just like we currently do with coronavirus. It doesn't matter what the lag time is in between being exposed and receiving a positive test. What we are interested in is # of positive tests, why is there a 3 year lag here?
- FalconSensei 6y agoCouldn't find on the linked article, but what's the lag for people who actually get tested? I mean, seems that this 3 years lag is because people only get tested if they have any apparent health issue and the doctor thinks it might be HIV. With Covid, it might take a few days for a test show positive, after exposure - say, Christmas dinner. If someone thinks they might have been exposed to HIV, how long until a test can safely tell it's a true negative/positive?
- deleted 6y ago[deleted]
- TimPC 6y agoI'm hopeful that this is a step towards getting an injectable on a longer time scale even though it's likely the treatment technology would be different. If we could get to something on a 2-year or 5-year time horizon we may just start giving it to everyone preventatively, the way we do tetanus shots. The larger volume might mean enough total profits at a price scale that makes it affordable for the pharma company to do that at a price point that makes sense for the buyer. If we get to a universal treatment that we can apply globally, we may see AIDS become a thing of the past in a few generations. Given unequal access to care that may be substantially challenging in regions with poor health care and we may need an outright vaccine that lasts permanently to successfully treat it globally. But this seems to be a step along that pathway even if new technologies are needed to complete it.
- lake-effect 6y agoPharmacy (i.e. the cost of drugs) is a big contributor to rising healthcare costs and injectables are an increasingly more popular and very expensive way to deliver drugs. This is a good example of how R&D and drug development works in the US. Invest time and energy in a much more profitable form of treatment for a disease that is already managed.
- xiphias2 6y agoAll the low hanging fruit for medical treatments have been done already, so right now it's incredibly hard to improve on the situation. I'm really hopeful though about the genetic revolution that's happening though, I just wish it was happening faster (my girlfriend just got diagnosed with cancer again today :( )
- refurb 6y agoPharmacy is about 10% of total healthcare costs so not a major driver of rising healthcare costs, but it gets a lot of media attention. And no, they didn’t create an injectable drug because it’s “popular”. They did it because it address compliance of oral therapies.
- gibybo 6y ago>Pharmacy is about 10% of total healthcare costs That's good to know and something I've been curious about. Do you have a source that breaks down the other 90%?
- refurb 6y agoOk, so I work in healthcare in the US and I read a lot of papers and think "well yeah, but that's not very actionable information". The best analysis I've found so far is from McKinsey.[1] They took a very clever approach to benchmark US healthcare spending to other OECD countries. They adjusted for US GDP (richer countries spend more on healthcare), then broke down costs by category and figured out how much more/less the US spent compared to OECD countries. Very eye opening if you check out the graph at the bottom of page 4. Findings: 1) out-patient care is driving ~70% of the extra cost, 2) in-patient costs are ~10% higher than OECD, 3) the US spend 50% more on drugs, but it's a small part of overall spending, 4) administration is 200% higher, but again, it doesn't add up to that much, 5) the US spends less on long-term and home care and 6) the US invests 50% more in healthcare, but it's not a large absolute amount. [1]https://www.mckinsey.com/~/media/mckinsey/dotcom/client_service/healthcare%20systems%20and%20services/health%20international/hi08_american_health.ashx https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
- limeblack 6y agoAs someone who is bipolar I will say I know many people including myself who need injections to be able to manage life. The injections may be abused by a percent of the population but there is a much smaller percent(disabled mainly) that need them.
- perardi 6y agoAs someone who is in this high-risk community: good news. (Well, except for that price tag.) People, to a first approximation, are just terrible at pill compliance. Doesn’t matter the demographics, people just aren’t perfect at taking a pill, every day, at the same time, forever and ever. Having that injection where you can set it and forget it? Nice advance. Not game-changing, but still a nice move forward. And I think it’ll be a bigger move forward for people who are at high risk of HIV, but also have not great access to medical care where they live. If you…oh boy, here I go, potentially getting into trouble. Non-white and/or non-affluent communities tend to come down much harder on homosexuality. It is much more discreet to get a periodic shot than heading to Walgreen’s and bringing home a bottle full of blue pills. It’s safer. It’s a bit more private.
- tyingq 6y agoIt's a shame that PrEP is still so expensive.
- perardi 6y agoIt’s frustrating that it’s so expensive for the most at-risk communities in the US. Because you can totally work the systems to get it affordably. Besides insurance, there are clinics, there are coupons, there are programs…but you have to have the information literacy and the time to figure out how to jump through all those hoops. Me, I work remotely, I have insurance, I live on the north side of Chicago, I can get my Truvada easily. You live on the west side of Chicago with no Howard Brown nearby, and you work a service sector job where your hours are algorithmically doled out to you? Far, far harder.
- monopoledance 6y agoI think, same as with vaccinations, this clearly highlights how all of society really benefits from universal health care. In fact, why isn't preventable infectious disease talked more about in that debate? Pretty obvious, no?
- deleted 6y ago
- abeppu 6y ago> The cost, however, is steep — the list, or wholesale, price is $3,960 a month, or more than $47,500 a year. The list price for the one-time initiation dose is $5,490. Median income in the US is ~$31K apparently. So even in a rich country, this is like 50% more than the income of a typical person. My understanding is the funding for the trials was partly from NIAID. This seems like yet another case where public funds are used for research, but a company ends up with the ability to dictate pricing. I'm glad that this works and that there is another, more convenient and effective treatment option. But shouldn't we have some setup where if tax dollars pay for the research, the government should own a share of the IP commensurate with their funding level, and should then be able to have some say in pricing? Or, if you think that the government itself shouldn't own IP for a product on the market, can we create an independent non-profit which receives ownership, and whose charter aligns with actually treating as many people as possible? I'm not saying that when real, innovative work happens, pharmaceutical companies shouldn't get some meaningful return on the money they put in. But when the public supports the work, we shouldn't get nothing.
- abeppu 6y agoOr to approach the same issue from the other direction: Does public funding for research of this type self-sabotage, if it enables pharmaceutical companies to set pricing at a level which meaningfully limits the use of the results of that research?
- jennyyang 6y agoAs someone who grew up in the 80s with the fullblown AIDS crisis, this really is a testament to human ingenuity. When we were kids, this sounded like the end of the world: a virus that attacks the immune system itself. It was so terrifying to hear about such a horrible disease that had no cure, and was so insidious that we couldn't even create a vaccine to stop it. In a few decades we as a species have found a way not only to completely eradicate it to undetectable levels (it still hides in cells to protect itself) but now we are at a monthly injection. The way we have created a vaccine for SARS-CoV-2 is also absolutely incredible. It's great to be alive these days, now if only we can get a firm solution over cancer and other diseases like dementia, etc!
- chrisfinazzo 6y ago> When we were kids, this sounded like the end of the world: a virus that attacks the immune system itself. It was so terrifying to hear about such a horrible disease that had no cure, and was so insidious that we couldn't even create a vaccine to stop it. I was born in '86. Even into the 90's this line of thinking hadn't changed all that much. The attitude around most diseases and the like that had a 'social' component was best described as "shock and shame" - e.g, you're screwed long-term and society blamed you. > In a few decades we as a species have found a way not only to completely eradicate it to undetectable levels (it still hides in cells to protect itself) but now we are at a monthly injection. I was going to ask how this works until you answered the question for me (if it's undetectable, why isn't this considered cured?) Last I heard research is still trying to figure this out. At the same time, I can remember hepatitis C having a similar wrap in the 90's - 'you have it, and probably always will' - Mavyret/Epclusa changed that. It still blows my mind that the problem is pretty much solved at this point. Hail Science.
- simonklitj 6y agoI think the reason it's not considered cured is because if you go off of your meds it'll (might?) return and potentially gain resistance to the medication. So it's more like keeping it in check through active medication, not curing it away: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/taking-your-hiv-medications-every-day https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treat....
- poz_throwaway 6y agoI’ve been HIV+ since I was 18 (mid-20’s now). I’ve taken the Gilead combo pills since a few months after I was diagnosed, first Stribild and now Genvoya, the difference being a new form of tenofovir. I miss probably one dose a month, maybe two. I don’t take my pill at the same time everyday, probably in a 4 or 5 hour window vs. the 2 hour window my doctor recommends. I’ve never had any side effects and I’ve been undetectable since I began treatment. I’m not sure I’m interested in this injectable regimen. My HIV treatment will last for the majority of my life; I don’t feel like I can risk any amount of reduced long term efficacy with a new drug. I also don’t love needles. I’m excited to talk to my doctor about it, though. Like birth control, the more options there are, the better. HIV treatment is truly a marvel of modern medicine.
- hsuduebc2 6y agoHow can standart income US citizen afford that? Have insurance before infection?
- perardi 6y agoSee the thread just down the page. Nobody actually pays that much for Truvada, the primary PrEP drug on the market now.
- 1970-01-01 6y agoIt feels like there has been a significant leap in treating common diseases, infections, and ailments during the last few years. Is there any data that can show it or is this just a happy feeling?