7 ms·

Would this be recommended for anybody sexually active? Or just for people in higher risk like someone with a partner that has HIV or if you're homosexual?

sschueller 5y ago
I guess people who have a lot of partners and unprotected sex such as people who do porn or sex workers as well as people with partners that are positive.
- koheripbal 5y ago
  Not to mention members of the gay community.
jcims 5y ago
As with any preventative medicine it boils down to risk/benefit and (unfortunately) economics. FDA approval process should expose most of the risk/benefit equation and the manufacturer will set the price. When all of that is said and done you will have a lot more information with which to consider your question.
bayesian_horse 5y ago
I think it will be rolled out to those most at risk at first, including those who are already infected. This may actually reduce the HIV infection rate to a large degree. Or people don't take the effing vaccine despite the benefits. Then yes, probably anybody sexually active should get it.
- admiral33 5y ago
  > probably anybody sexually active should get it. Agree - if we can get rid of HIV we should. I looked at the exclusion criteria in the trial and it didn't mention use of a prophylactic. Widely available prophylactics have been a huge success with preventing HIV, I wonder how that will impact the trial. https://clinicaltrials.gov/ct2/show/NCT05001373 https://clinicaltrials.gov/ct2/show/NCT05001373
  - bayesian_horse 5y ago
    No, the point is that you could probably extinguish HIV with a very low vaccination rate - if the vaccination rate in the at-risk population is high enough. "Anybody taking the vaccine" (not "everybody") will actually not eradicate the virus, but rather protect those who take the vaccine. Much like now with Covid.
  - bayesian_horse 5y ago
    The prophylactics should not affect clinical trials a lot. Obviously the organizers need to track who also takes prophylactics. It would be unethical to only enroll participants (especially those at higher risk) who don't take prophylactics because they could get the placebo and then they have zero protection. Everything else is just a question of the statistical signal detection. Those Studies are planned and designed to provide such a signal, with all we know about HIV prevalence (which is already quite low, in most industrial countries, speaking statistically and for the overall population) and the effectiveness of prophylactic treatment. Also what I'm hearing the prophylactic treatment is not much fun either... I rather see the danger of participants getting the placebo, drop the prophylactics and think they are protected...
eplanit 5y ago
Given the new mindset that's forming, maybe this vaccine should be required. /s Sarcasm aside, I'd be curious to know if there's anyone who wants to require Covid vaccinations, but to let ones like this remain voluntary.
gadders 5y ago
I hope it's cheap enough to deploy large volumes to Africa. Desperately needed there.
- umvi 5y ago
  Unpopular opinion but Africa also desperately needs to fix the root cause of its HIV spread. Maybe this vaccine would give some relief and give them a chance to start over, but if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut.
  - lthornberry 5y ago
    Yikes. This is actually a field that I do research in, and this analysis just really, really doesn't hold water. Of course there are sociological contributors to the spread of HIV on the African continent. But the idea that there's a "culture of rape" is pretty far off base, if only because Africa is an incredibly diverse continent so there's not a shared culture of pretty much anything. For a much more accurate look at the development of the AIDS pandemic in Africa, I recommend Jacques Pépin, The Origin of AIDS.
    - umvi 5y ago
      Yeah, I probably could have phrased my original comment better. I didn't mean to imply the areas in Africa with HIV issues have a culture of rape. I said "if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut." (emphasis added). My point being, if we have a magic pill that cures them of a given STD, but there are underlying cultural problems that contribute to elevated STD transmission (such as unprotected sex or rape), etc., then the magic pill is only a bandaid that doesn't address the underlying elevated STD transmission problem. As a sibling comment stated, maybe the problem is that these Africans believe homeopathic cures like special tea leaves will protect them from HIV when in reality they are just all having unprotected sex, so it's both a cultural and educational issue.
da_big_ghey 5y ago
I will tell you at right now even if it has a recommendation for all people many will not in first world. HIV still is "gay disease" to most thinking and many will not want to admit risk of getting it. This is largest problem to solve if you are wanting to remove HIV from population. I think maybe best focus are bi sexuals, they are representing "cross over point" from gay population into straights where it maybe can spread more in future.
- ddingus 5y ago
  Indeed. There are people wanting there to be a gay disease, and may actually oppose research to preserve what they see as a natural form of personal judgment.
  - throw3849 5y ago
    It goes both ways. Some people also see HIV as part of "gay culture" and want to protect it as such. For example bugchasing or reduction of penalties for HIV spreading.
    - ddingus 5y ago
      There are multiple ways actually. This is not a tit for tat kind of thing. No one I know, who are gay or otherwise just not a normie in these things, would want, or have expressed HIV something needing to be preserved, continuing to exist and do the great harm in this world that it does. Maybe you do. That just has not been my experience.
- ddingus 5y ago
  One would also think of confusion in people as a shared risk regardless of where any of us may be. Despite best efforts, everyone has a risk unless they are inactive.
grumblenum 5y ago
That depends. Do senior CDC or NIH staff stand to collect patent royalties on its administration? The former (and probably informally mandatory). If not, then the latter. Given Stéphane Bancel's and others' recent trading, then I wouldn't bank on this one being a winner.
_trampeltier 5y ago
At moment there is PrEP for that case. https://www.cdc.gov/hiv/basics/prep.html https://www.cdc.gov/hiv/basics/prep.html I think the idea in long term would, should be to replace PrEP.
- Traubenfuchs 5y ago
  I think marketingwise the vaccine will have a very, very hard time against PrEP, unless it can be proven that it's just as effective. And what about booster shots? It would be highly unethical to give someone an experimental vaccine INSTEAD of just PrEP. But if we don't do that, we can never find out how good the vaccine works. A dilemma.
  - bluGill 5y ago
    > I think marketingwise the vaccine will have a very, very hard time against PrEP Probably not. PrEP has some nasty side effects. Those who take it need to get their organ function checked every few months (I think just kidneys?). Of course this vaccine is just entering trials. We have no idea how effective it is, or what the side effects might be. As such we can only guess and hope that it is better than PrEP - though that is a somewhat low bar.
    - vsef 5y ago
      To be clear, Truvada (or Descovy) for vast majority of people will have essentially no side effects. There is a small increase in chance of kidney disease, mainly for those with other risk factors, the risk profile is similar to over the counter ibuprofen. "HIV-positive individuals who use Truvada to control their infection are more likely to experience kidney damage and bone density loss than those who take it to prevent HIV infection, as so-called pre-exposure prophylaxis (PrEP)[2]. But “no significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years,” according to the U.S. Department of Health and Human Services. Numerous studies have shown that the risk of HIV-negative Truvada users developing kidney disease is not statistically significantly different from those taking placebo[3]." https://healthfeedback.org/claimreview/hiv-drug-truvada-linked-to-kidney-damage-and-bone-density-loss-but-risks-are-low-and-usually-outweighed-by-the-drugs-benefits/ https://healthfeedback.org/claimreview/hiv-drug-truvada-link...
nomagicbullet 5y ago
> or if you're homosexual? HIV transmission is related to sexual activity not sexual orientation. Being in an open relationship, cheating on your partner, performing unprotected sex, are all examples of behaviors that put people at "higher risk". Being attracted to your own gender does not.
- switch007 5y ago
  They knew that.
- 411111111111111 5y ago
  There is a correlation between unprotected anal intercourse and HIV, which is why male homosexuals are especially at danger.
- pavelrub 5y ago
  HIV transmission is partially related to attributes that are correlated with sexual orientation, the most prominent of which is the fact that the chance of transmission is much higher for anal sex than it is for vaginal sex.
  - Broken_Hippo 5y ago
    From personal experience, anal sex is definitely not limited to sex between men. I'm going to guess that there are entire websites dedicated to that, and there are definitely sections of porn websites dedicated to it. Additionally, sex between men encompasses much more than anal sex. Which all goes back to teh point: HIV transmission isn't related to sexual orientation, even if some sex acts are traditionally attributed to one specific sort of orientation.
    - pavelrub 5y ago
      The argument you are addressing is a strawman. Nobody claimed that anal sex is limited only to sex between men. Anal sex is, however, far more common in frequency among homosexual men than between heterosexual couples, and significantly increases the risk of HIV transmission compared to vaginal sex, therefore it is a risk factor that is strongly correlated with sexual orientation.
hannob 5y ago
These aren't really the questions to be asked when they just started with a first trial. If it's 99% effective and has close to zero sideeffects that's very different from 60% effective and significant sideeffects. In both cases there are probably some people you'd recommend it to, but in the first case you may just recommend it to everyone, in the second case probably not.
- koheripbal 5y ago
  Given that it requires sexual contact to contract, I bet we could vaccinate a small portion of high risk people and effectively eradicate the disease entirely, without ever needing to vaccinate everyone.
  - MagnumOpus 5y ago
    > vaccinate a small portion of high risk people and effectively eradicate the disease You could remove it as an endemic disease in the US and Europe. In places like South Africa where a third of the population is infected, nothing less that a blanket vaccination campaign would work. (And of course it is not easy to find out who the high risk people are when both HIV and sexual promiscuity are stigmatised, so you might need to vaccinate everyone anyway to avoid costly errors...)
  - Eric_WVGG 5y ago
    Too bad it doesn't require sexual contact to contract.
    - Vecr 5y ago
      You mean HIV? Yeah, you can get it from fluid-to-blood contact, accidentally getting yourself with a needle, or someone trying to use a contaminated needle as a bio-weapon. Microscopic cuts under your fingernails are important, so you should wear gloves for sure.
vidarh 5y ago
It's tricky, because between condoms, PREP and PEP (pre- and post-exposure drugs) and treatments now being good enough that life expectancy with HIV is nearly the same as without, it'd take very low risks of side effects before giving it to everyone would cause more harm than not giving it. So the safety profile will be hugely important in determining how widely to use it.
- jeofken 5y ago
  What is the market price for such treatments?

sschueller 5y ago

I guess people who have a lot of partners and unprotected sex such as people who do porn or sex workers as well as people with partners that are positive.

koheripbal 5y ago
Not to mention members of the gay community.

jcims 5y ago

As with any preventative medicine it boils down to risk/benefit and (unfortunately) economics. FDA approval process should expose most of the risk/benefit equation and the manufacturer will set the price. When all of that is said and done you will have a lot more information with which to consider your question.

bayesian_horse 5y ago

I think it will be rolled out to those most at risk at first, including those who are already infected. This may actually reduce the HIV infection rate to a large degree. Or people don't take the effing vaccine despite the benefits. Then yes, probably anybody sexually active should get it.

admiral33 5y ago
> probably anybody sexually active should get it. Agree - if we can get rid of HIV we should. I looked at the exclusion criteria in the trial and it didn't mention use of a prophylactic. Widely available prophylactics have been a huge success with preventing HIV, I wonder how that will impact the trial. https://clinicaltrials.gov/ct2/show/NCT05001373 https://clinicaltrials.gov/ct2/show/NCT05001373
- bayesian_horse 5y ago
  No, the point is that you could probably extinguish HIV with a very low vaccination rate - if the vaccination rate in the at-risk population is high enough. "Anybody taking the vaccine" (not "everybody") will actually not eradicate the virus, but rather protect those who take the vaccine. Much like now with Covid.
- bayesian_horse 5y ago
  The prophylactics should not affect clinical trials a lot. Obviously the organizers need to track who also takes prophylactics. It would be unethical to only enroll participants (especially those at higher risk) who don't take prophylactics because they could get the placebo and then they have zero protection. Everything else is just a question of the statistical signal detection. Those Studies are planned and designed to provide such a signal, with all we know about HIV prevalence (which is already quite low, in most industrial countries, speaking statistically and for the overall population) and the effectiveness of prophylactic treatment. Also what I'm hearing the prophylactic treatment is not much fun either... I rather see the danger of participants getting the placebo, drop the prophylactics and think they are protected...

eplanit 5y ago

Given the new mindset that's forming, maybe this vaccine should be required. /s Sarcasm aside, I'd be curious to know if there's anyone who wants to require Covid vaccinations, but to let ones like this remain voluntary.

gadders 5y ago

I hope it's cheap enough to deploy large volumes to Africa. Desperately needed there.

umvi 5y ago
Unpopular opinion but Africa also desperately needs to fix the root cause of its HIV spread. Maybe this vaccine would give some relief and give them a chance to start over, but if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut.
- lthornberry 5y ago
  Yikes. This is actually a field that I do research in, and this analysis just really, really doesn't hold water. Of course there are sociological contributors to the spread of HIV on the African continent. But the idea that there's a "culture of rape" is pretty far off base, if only because Africa is an incredibly diverse continent so there's not a shared culture of pretty much anything. For a much more accurate look at the development of the AIDS pandemic in Africa, I recommend Jacques Pépin, The Origin of AIDS.
  - umvi 5y ago
    Yeah, I probably could have phrased my original comment better. I didn't mean to imply the areas in Africa with HIV issues have a culture of rape. I said "if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut." (emphasis added). My point being, if we have a magic pill that cures them of a given STD, but there are underlying cultural problems that contribute to elevated STD transmission (such as unprotected sex or rape), etc., then the magic pill is only a bandaid that doesn't address the underlying elevated STD transmission problem. As a sibling comment stated, maybe the problem is that these Africans believe homeopathic cures like special tea leaves will protect them from HIV when in reality they are just all having unprotected sex, so it's both a cultural and educational issue.

da_big_ghey 5y ago

I will tell you at right now even if it has a recommendation for all people many will not in first world. HIV still is "gay disease" to most thinking and many will not want to admit risk of getting it. This is largest problem to solve if you are wanting to remove HIV from population. I think maybe best focus are bi sexuals, they are representing "cross over point" from gay population into straights where it maybe can spread more in future.

ddingus 5y ago
Indeed. There are people wanting there to be a gay disease, and may actually oppose research to preserve what they see as a natural form of personal judgment.
- throw3849 5y ago
  It goes both ways. Some people also see HIV as part of "gay culture" and want to protect it as such. For example bugchasing or reduction of penalties for HIV spreading.
  - ddingus 5y ago
    There are multiple ways actually. This is not a tit for tat kind of thing. No one I know, who are gay or otherwise just not a normie in these things, would want, or have expressed HIV something needing to be preserved, continuing to exist and do the great harm in this world that it does. Maybe you do. That just has not been my experience.
ddingus 5y ago
One would also think of confusion in people as a shared risk regardless of where any of us may be. Despite best efforts, everyone has a risk unless they are inactive.

grumblenum 5y ago

That depends. Do senior CDC or NIH staff stand to collect patent royalties on its administration? The former (and probably informally mandatory). If not, then the latter. Given Stéphane Bancel's and others' recent trading, then I wouldn't bank on this one being a winner.

_trampeltier 5y ago

At moment there is PrEP for that case. https://www.cdc.gov/hiv/basics/prep.html https://www.cdc.gov/hiv/basics/prep.html I think the idea in long term would, should be to replace PrEP.

Traubenfuchs 5y ago
I think marketingwise the vaccine will have a very, very hard time against PrEP, unless it can be proven that it's just as effective. And what about booster shots? It would be highly unethical to give someone an experimental vaccine INSTEAD of just PrEP. But if we don't do that, we can never find out how good the vaccine works. A dilemma.
- bluGill 5y ago
  > I think marketingwise the vaccine will have a very, very hard time against PrEP Probably not. PrEP has some nasty side effects. Those who take it need to get their organ function checked every few months (I think just kidneys?). Of course this vaccine is just entering trials. We have no idea how effective it is, or what the side effects might be. As such we can only guess and hope that it is better than PrEP - though that is a somewhat low bar.
  - vsef 5y ago
    To be clear, Truvada (or Descovy) for vast majority of people will have essentially no side effects. There is a small increase in chance of kidney disease, mainly for those with other risk factors, the risk profile is similar to over the counter ibuprofen. "HIV-positive individuals who use Truvada to control their infection are more likely to experience kidney damage and bone density loss than those who take it to prevent HIV infection, as so-called pre-exposure prophylaxis (PrEP)[2]. But “no significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years,” according to the U.S. Department of Health and Human Services. Numerous studies have shown that the risk of HIV-negative Truvada users developing kidney disease is not statistically significantly different from those taking placebo[3]." https://healthfeedback.org/claimreview/hiv-drug-truvada-linked-to-kidney-damage-and-bone-density-loss-but-risks-are-low-and-usually-outweighed-by-the-drugs-benefits/ https://healthfeedback.org/claimreview/hiv-drug-truvada-link...

nomagicbullet 5y ago

> or if you're homosexual? HIV transmission is related to sexual activity not sexual orientation. Being in an open relationship, cheating on your partner, performing unprotected sex, are all examples of behaviors that put people at "higher risk". Being attracted to your own gender does not.

switch007 5y ago
They knew that.
411111111111111 5y ago
There is a correlation between unprotected anal intercourse and HIV, which is why male homosexuals are especially at danger.
pavelrub 5y ago
HIV transmission is partially related to attributes that are correlated with sexual orientation, the most prominent of which is the fact that the chance of transmission is much higher for anal sex than it is for vaginal sex.
- Broken_Hippo 5y ago
  From personal experience, anal sex is definitely not limited to sex between men. I'm going to guess that there are entire websites dedicated to that, and there are definitely sections of porn websites dedicated to it. Additionally, sex between men encompasses much more than anal sex. Which all goes back to teh point: HIV transmission isn't related to sexual orientation, even if some sex acts are traditionally attributed to one specific sort of orientation.
  - pavelrub 5y ago
    The argument you are addressing is a strawman. Nobody claimed that anal sex is limited only to sex between men. Anal sex is, however, far more common in frequency among homosexual men than between heterosexual couples, and significantly increases the risk of HIV transmission compared to vaginal sex, therefore it is a risk factor that is strongly correlated with sexual orientation.

hannob 5y ago

These aren't really the questions to be asked when they just started with a first trial. If it's 99% effective and has close to zero sideeffects that's very different from 60% effective and significant sideeffects. In both cases there are probably some people you'd recommend it to, but in the first case you may just recommend it to everyone, in the second case probably not.

koheripbal 5y ago
Given that it requires sexual contact to contract, I bet we could vaccinate a small portion of high risk people and effectively eradicate the disease entirely, without ever needing to vaccinate everyone.
- MagnumOpus 5y ago
  > vaccinate a small portion of high risk people and effectively eradicate the disease You could remove it as an endemic disease in the US and Europe. In places like South Africa where a third of the population is infected, nothing less that a blanket vaccination campaign would work. (And of course it is not easy to find out who the high risk people are when both HIV and sexual promiscuity are stigmatised, so you might need to vaccinate everyone anyway to avoid costly errors...)
- Eric_WVGG 5y ago
  Too bad it doesn't require sexual contact to contract.
  - Vecr 5y ago
    You mean HIV? Yeah, you can get it from fluid-to-blood contact, accidentally getting yourself with a needle, or someone trying to use a contaminated needle as a bio-weapon. Microscopic cuts under your fingernails are important, so you should wear gloves for sure.

vidarh 5y ago

It's tricky, because between condoms, PREP and PEP (pre- and post-exposure drugs) and treatments now being good enough that life expectancy with HIV is nearly the same as without, it'd take very low risks of side effects before giving it to everyone would cause more harm than not giving it. So the safety profile will be hugely important in determining how widely to use it.

jeofken 5y ago
What is the market price for such treatments?