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I 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%

I 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 ago
I 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 ago
  Biktarvy 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 ago
The 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
- dougmwne 6y ago
  Truvada is commonly taken proactively by sexually active people in high risk categories. It is true that it has side effects, so the risk of those needs to be balanced against the risk of HIV exposure.
  - Grazester 6y ago
    Yes I do know it is take by high risk sexually active people. But I was wondering about health workers themselves and in what health field exactly.
- blithedale 6y ago
  Truvada is PREP. PRE exposure prophylaxis. PEP =/= PREP. PEP is after the fact treatment, there's more than just Truvada in that protocol. PEP is typically much harder on the body than PREP. Most every gay man I know takes PREP with few or no side effects.
- vsef 6y ago
  The side effects are of the type where a small group of users will experience changes in kidney function, and you have to check for it, but the vast majority won't. The side effect profile for most people is very low.
daniel957 6y ago
Logistics-wise, it’s easier to get someone to come into the doctors for blood work every 3 months for testing (as required for prep) than once a month for a shot. However, from reading the article, I do think there’s a convenience factor at play related to the struggles of taking pills daily. Note though, the article mentioned a trial of _women_ where truvada and one-shot prevention effectiveness were compared and the one-shot was deemed 89% more effective. A quick search explains _why_ this might be the case for women. Basically, it takes more truvada to get rid of the disease in vaginal and cervical tissue than it takes for rectal tissue. Source: https://www.uspharmacist.com/article/why-do-women-need-higher-dose-of-truvada-to-prevent-hiv-infection https://www.uspharmacist.com/article/why-do-women-need-highe... Also, doctors have been recommending a different drug, Descovy, for prep instead of Truvada. This isn’t due to effectiveness but side effects I believe. I guess if one experienced side effects though, they would be less likely to continue taking the medicine.
- damnyou 6y ago
  I'm not sure about this one but subcutaneous and intramuscular injectables are pretty easy to self-administer. I self-inject once a week myself. https://www.poz.com/drug/cabenuva https://www.poz.com/drug/cabenuva seems to suggest it is intramuscular (administered in the buttocks, which is not hard to do by oneself) but requires a healthcare provider. Not sure why, there might be storage requirements and such.
  - daniel957 6y ago
    I think people would rather prefer to take a pill than give themselves an injection. It doesn’t matter if it’s “easy” or not. There’s the “ick” or “ahhh needle” or “breaking skin” factor at play. Even if you self-inject and find it easy, I’m sure you’re not saying it’s easier and less of a hassle than taking a pill lmao.
    - stickfigure 6y ago
      Depo-Provera (monthly injected contraceptive) is used by over 2 million women in the US.
gizmo686 6y ago
It is a decrease in already low transmission. For ethical reasons, the placebo group is not no treatment, but rather current standard of care. I had to do some digging to find any source on the effectiveness on preventing transmission (the recent FDA approval is for post infection treatment). The study I found is [0]. In a double blinded study of 4,600 participants, half were given the cabotegravir injection, and half were given the daily oral treatment. The study notes a "high level of adherence to oral therapy"; however, the actual numbers on adherence are: > Adherence to oral FTC/TDF was high, based on a random subset sampling that detected tenofovir (> 0.31 ng/ml) in 87% of all samples tested. I'm not qualified to say if this actually indicates 87% adherence, or if a fully compliant patient may get a negative result on that test. The result of this study was that 50 particpants got HIV, of which 12 were on the injectable and 38 were on the oral. By my calculation, this gives a relative effectiveness of (38-13)/38 = 68.4%, although the paper reports 69%. [0] https://viivhealthcare.com/en-us/us-news/us-articles/2020/global-hiv-prevention-study-to-stop-early-after-viiv-healthcares/ https://viivhealthcare.com/en-us/us-news/us-articles/2020/gl...
- dougmwne 6y ago
  This is awesome, thank you! The likelihood of pill compliance does seem to be probably higher than normal since everyone had 2 month follow-up appointments for injections, plus presumably they knew they were being blood tested. This looks like a game changer for HIV prevention. 6 shots a year and you can have better protection than any other known method. To me it looks like this is something that should be rapidly adopted.
- Blikkentrekker 6y ago
  > It is a decrease in already low transmission. For ethical reasons, the placebo group is not no treatment, but rather current standard of care. I see nothing wrong with sacrificing a few men, who consent and sign up and know the risk, for the far larger majority. If better drugs can be developed that would serve millions by sacrificing a hundred consenting subjects that know they run this risk, that seems like an overall benefit to me. It seems rather irrational to not be willing to do this. — It is fine if men die, so long as their blood not be on my hands directly, but only indirectly.
heavyset_go 6y ago
Compliance is a big issue, as is price. In the US, Truvada's retail price is about $2,000 for a 30 day supply. Truvada costs about $40 in other countries.
- taurath 6y ago
  Compliance is a huge issue because health insurance will do a lot to make you jump through huge hoops to get it. I have had prescriptions “disappear” into the CVS “specialty pharmacy” and you have to wait on the phone for hours for them to “find” it.
  - maxerickson 6y ago
    I helped my mom deal with 2 specialty pharmacies for some Parkinson's drugs she was taking. The drugs weren't available from other pharmacies (that CVS runs one of the largest specialty pharmacies can make this confusing, but normal CVS probably don't stock it if the prescription goes to their specialty pharmacy). They present themselves as helping the patient navigate a complex drug, but in practice this just meant they had a bunch of questions to tick off each time you talked to them. Their outreach and phone tree were both pretty bad, clearly designed for high operator utilization and not customer service.

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 ago

I 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 ago
Biktarvy 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 ago

The 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

dougmwne 6y ago
Truvada is commonly taken proactively by sexually active people in high risk categories. It is true that it has side effects, so the risk of those needs to be balanced against the risk of HIV exposure.
- Grazester 6y ago
  Yes I do know it is take by high risk sexually active people. But I was wondering about health workers themselves and in what health field exactly.
blithedale 6y ago
Truvada is PREP. PRE exposure prophylaxis. PEP =/= PREP. PEP is after the fact treatment, there's more than just Truvada in that protocol. PEP is typically much harder on the body than PREP. Most every gay man I know takes PREP with few or no side effects.
vsef 6y ago
The side effects are of the type where a small group of users will experience changes in kidney function, and you have to check for it, but the vast majority won't. The side effect profile for most people is very low.

daniel957 6y ago

Logistics-wise, it’s easier to get someone to come into the doctors for blood work every 3 months for testing (as required for prep) than once a month for a shot. However, from reading the article, I do think there’s a convenience factor at play related to the struggles of taking pills daily. Note though, the article mentioned a trial of _women_ where truvada and one-shot prevention effectiveness were compared and the one-shot was deemed 89% more effective. A quick search explains _why_ this might be the case for women. Basically, it takes more truvada to get rid of the disease in vaginal and cervical tissue than it takes for rectal tissue. Source: https://www.uspharmacist.com/article/why-do-women-need-higher-dose-of-truvada-to-prevent-hiv-infection https://www.uspharmacist.com/article/why-do-women-need-highe... Also, doctors have been recommending a different drug, Descovy, for prep instead of Truvada. This isn’t due to effectiveness but side effects I believe. I guess if one experienced side effects though, they would be less likely to continue taking the medicine.

damnyou 6y ago
I'm not sure about this one but subcutaneous and intramuscular injectables are pretty easy to self-administer. I self-inject once a week myself. https://www.poz.com/drug/cabenuva https://www.poz.com/drug/cabenuva seems to suggest it is intramuscular (administered in the buttocks, which is not hard to do by oneself) but requires a healthcare provider. Not sure why, there might be storage requirements and such.
- daniel957 6y ago
  I think people would rather prefer to take a pill than give themselves an injection. It doesn’t matter if it’s “easy” or not. There’s the “ick” or “ahhh needle” or “breaking skin” factor at play. Even if you self-inject and find it easy, I’m sure you’re not saying it’s easier and less of a hassle than taking a pill lmao.
  - stickfigure 6y ago
    Depo-Provera (monthly injected contraceptive) is used by over 2 million women in the US.

gizmo686 6y ago

It is a decrease in already low transmission. For ethical reasons, the placebo group is not no treatment, but rather current standard of care. I had to do some digging to find any source on the effectiveness on preventing transmission (the recent FDA approval is for post infection treatment). The study I found is [0]. In a double blinded study of 4,600 participants, half were given the cabotegravir injection, and half were given the daily oral treatment. The study notes a "high level of adherence to oral therapy"; however, the actual numbers on adherence are: > Adherence to oral FTC/TDF was high, based on a random subset sampling that detected tenofovir (> 0.31 ng/ml) in 87% of all samples tested. I'm not qualified to say if this actually indicates 87% adherence, or if a fully compliant patient may get a negative result on that test. The result of this study was that 50 particpants got HIV, of which 12 were on the injectable and 38 were on the oral. By my calculation, this gives a relative effectiveness of (38-13)/38 = 68.4%, although the paper reports 69%. [0] https://viivhealthcare.com/en-us/us-news/us-articles/2020/global-hiv-prevention-study-to-stop-early-after-viiv-healthcares/ https://viivhealthcare.com/en-us/us-news/us-articles/2020/gl...

dougmwne 6y ago
This is awesome, thank you! The likelihood of pill compliance does seem to be probably higher than normal since everyone had 2 month follow-up appointments for injections, plus presumably they knew they were being blood tested. This looks like a game changer for HIV prevention. 6 shots a year and you can have better protection than any other known method. To me it looks like this is something that should be rapidly adopted.
Blikkentrekker 6y ago
> It is a decrease in already low transmission. For ethical reasons, the placebo group is not no treatment, but rather current standard of care. I see nothing wrong with sacrificing a few men, who consent and sign up and know the risk, for the far larger majority. If better drugs can be developed that would serve millions by sacrificing a hundred consenting subjects that know they run this risk, that seems like an overall benefit to me. It seems rather irrational to not be willing to do this. — It is fine if men die, so long as their blood not be on my hands directly, but only indirectly.

heavyset_go 6y ago

Compliance is a big issue, as is price. In the US, Truvada's retail price is about $2,000 for a 30 day supply. Truvada costs about $40 in other countries.

taurath 6y ago
Compliance is a huge issue because health insurance will do a lot to make you jump through huge hoops to get it. I have had prescriptions “disappear” into the CVS “specialty pharmacy” and you have to wait on the phone for hours for them to “find” it.
- maxerickson 6y ago
  I helped my mom deal with 2 specialty pharmacies for some Parkinson's drugs she was taking. The drugs weren't available from other pharmacies (that CVS runs one of the largest specialty pharmacies can make this confusing, but normal CVS probably don't stock it if the prescription goes to their specialty pharmacy). They present themselves as helping the patient navigate a complex drug, but in practice this just meant they had a bunch of questions to tick off each time you talked to them. Their outreach and phone tree were both pretty bad, clearly designed for high operator utilization and not customer service.