
A Blue Pill Is Stopping HIV, World-First Study Shows - startupflix
https://www.bloomberg.com/news/articles/2018-10-17/a-blue-pill-is-stopping-hiv-world-first-study-shows
======
matthewmacleod
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
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.

~~~
chimeracoder
> 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).

~~~
jsperx
I have personally paid $1700 out of pocket for a month’s supply of PrEP,
despite insurance AND membership in Gilead’s “advancing access” co-pay
assistance program.

Gilead intended the program to cover about $300/mo, in order to cover your co-
pay until your deductible is satisfied. That worked fine until this year, when
UnitedHealthcare decided to re-class my card from co-pay assistance to a
“manufacturer’s coupon” — thus accepting Gilead’s money while it lasted but
still expecting me to pickup the full tab until my deductible.

:(

~~~
voycey
The prices were similar here in Australia, friends who are on it were given
instructions by their doctor on websites in South Africa and a particular
brand name to purchase along with a prescription to get around it. Generic
version but equally as effective. I believe now it is on the PBS here!

------
DenisM
Developed by Gilead, the same company that created the Hep-C cure Sovaldi.
Some kick-ass work there.

~~~
tpetry
Have been googling Solvadi. Wow, curable hepatitis c is a big achievemt. But
it‘s insanely expensive. It has to be taken daily for at least 12 weeks, with
each pill costing 400€! The chance of curing is at 90%.

~~~
tptacek
That sounds pretty inexpensive. It looks like the previous standard of care
cost $10-15,000 and wasn't generally curative. Meanwhile, the long-term cost
of a progressing hep-c infection is quite high.

~~~
metildaa
In the context of a decietful medical system that bills pie in the sky amounts
for rendering basic care, a $100k cure for Hepatitis C might seem reasonable.
But those who need it most are dying due to this pricing scam, which is
standard for our healthcare in the US.

~~~
chimeracoder
> But those who need it most are dying due to this pricing scam, which is
> standard for our healthcare in the US.

Those who need it _most_ are dying not due to the "pricing scam", but because
they're incarcerated and therefore prohibited from receiving curative HCV
treatment, at any price.

The sticker price is high, but it's meaningless, because almost nobody is
going to be paying the sticker price.

Also, if you want to make a statement about healthcare pricing in the US,
Sovaldi is literally the worst example you could pick. For the first few years
after it was available outside the US, Sovaldi was significantly _cheaper_ in
the US than in it was elsewhere.

~~~
metildaa
There are 3 million people living in the US with Hepatitis C, many who are
needlessly dying from it are not incarcerated. The sticker price is a scam to
make insurers feel good when they get double digit percentage discounts, while
still lining Gileads pockets.

~~~
tptacek
I'm sympathetic to the argument, but it doesn't have much to do with my point,
and I'm more interested in the economics of new therapies than I am in a moral
or political debate about how medicine is financed.

------
denzil_correa
Since April 1 2018, PrEP is subsidised by Australia under the Pharmaceutical
Benefits Scheme (PBS). Thus, it costs $39.5 per script ($6.40 concessional
rate) [0, 1]. Earlier, it could cost as high as $10,000 a year [2].

[0] [https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-
to-b...](https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-be-added-
to-the-PBS)

[1] [https://www.healthdirect.gov.au/pharmaceutical-benefits-
sche...](https://www.healthdirect.gov.au/pharmaceutical-benefits-scheme-pbs)

[2] [https://www.theguardian.com/australia-
news/2018/feb/08/hiv-p...](https://www.theguardian.com/australia-
news/2018/feb/08/hiv-prevention-drug-prep-likely-to-be-approved-for-federal-
subsidy)

------
drewmassey
For me the biggest surprise in the article is that there are 180,000 men in
the United States on Prep. Given a back of the envelope calculation of 4.8m
out gay men in America (3% of population) that means adoption is itself around
3%.

Somehow I imagined truvada was more widey adopted but perhaps it is just
heavily marketed on the east coast.

~~~
jschwartzi
There are side-effects of PrEP for long-term use. It can cause kidney damage.
So it's not an entirely risk-free magic pill.

It's still much safer to only have sex while in a monagamous relationship
where you and your partner have been tested for HIV. And checking test results
before having sex with someone is also a very safe practice that is really
common. But in the end if you're often sleeping with people who you don't
trust, PrEP can be worth the risk.

~~~
chimeracoder
> It's still much safer to only have sex while in a monagamous relationship
> where you and your partner have been tested for HIV. And checking test
> results before having sex with someone is also a very safe practice that is
> really common. But in the end if you're often sleeping with people who you
> don't trust, PrEP can be worth the risk.

Please stop spreading anti-PrEP misinformation.

Statistically, it is literally safer to be on PrEP and have multiple partners
of unknown status than it is to be in a monogamous relationship and not be on
PrEP.

~~~
jschwartzi
Actually I've been googling around since you've said this, and I can find WHO
and CDC booklets indicating that PrEP is generally safe. In fact, the WHO
indicates that PrEP is as safe as placebo in the populations that have been
studied.

[http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_H...](http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf)

It's interesting because some of the gay men I spoke with about PrEP seemed to
think there were significant risks of kidney damage from long-term use. I
wonder where they got their information from.

~~~
thisiszilff
There is risk for some men, but at least here, you go in regularlynfor
checkups to ensure there are no problems. Only a small number have the side
effects, and these discontinue treatment.

------
Retric
Graph seems to be comparing 6 months of 2018 with full years before that which
would vastly overstate the decline.

~~~
akovaski
This is misleading to the point that I would consider this lying to the
audience. It's just wrong to convey the data in this way. The note below the
graph does not make this OK.

If anybody is interested in the actual data, I think the data is pulled from
"NSW HIV Surveillance Data Reports":
[https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-
data...](https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data.aspx)

~~~
thanatosmin
Yep, look at Figure 1:
[https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018...](https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018-nsw-
hiv-data-report.pdf)

The trend seems to be downward, but it's more like ~10% in the past couple
years than a step change.

------
killjoywashere
Interesting problem we're dealing with: Truvada potentially makes it harder to
identify HIV+ blood donors (as their antibody titers fall naturally over time)
and raises the question of whether HIV+ individuals will be more likely to
attempt to donate in order to "prove they're safe". It is a well-known fact in
their community that men having sex with men are deferred from being blood
donors for 12 months from last male intercourse, and there is at least a vocal
minority in the community which feels this is unjust. Presently, there is no
approved question for the donor questionnairre along the lines of "Are you
using Truvada?" but it is a hotly debated topic among blood bankers.

~~~
esf
Truvada does nothing to change identification of HIV+ donors. Truvada does not
change response to HIV tests, an HIV+ person taking Truvada as part of
treatment does not stop testing positive for HIV antibodies. Nothing changes
from the existing blood donation situation due to Truvada.

~~~
killjoywashere
Like most things in science, be suspicious of pure logical arguments. The
question for any test, even a true-false, is first a matter of "how much".
Antibodies fade over _time_ , ergo various vaccine boosters, such as tetanus.
At some point, we can't detect it.

~~~
dogma1138
I don’t know why is this being downvoted.

Anti bodies are produced to combat a pathogen if the levels of the pathogen
are below of what would trigger the immune system you will not produce anti
bodies and the ones that you have had produced will fade of over time you
don’t have anti bodies for every pathogen you encounter flowing through your
blood that would likely kill you.

If the pill can reduce the virus to trace levels and prevent HIV from
developing into AIDS it’s not unreasonable to question if it can affect
current HIV detection protocols.

Heck it wouldn’t surprise me if they measured the levels of anti bodies
dropping while the levels of immune cells remaining normal to test the
efficiency of the new drug.

That said I know some HIV tests check for the levels of virions in the blood
these are often used for AIDS prognosis I don’t know how sensitive these are
and if they’ll be able to detect trace levels of the virus if anti bodies
response tests will become unreliable.

Also like with everything it’s not binary if this new treatment regiment can
reduce the effectiveness of HIV testing by any meaningful margin it will be a
problem.

I have very hard time believing that current HIV testing is 100% false
negative proof.

~~~
esf
The pill was already part of HIV trratment, it does nothing to change the
effectiveness of HIV tests.

The only unknown would be whether if you are one of the very, very few people
that manages to contract HIV while taking prep, your antibody response is
different during that initial window.

But: Anyone in that situation is already covered by the questions about recent
partners and already is not donating if answering the existing questions in
good faith. If they are donating in this situation at all they are already
just ignoring the questions.

~~~
dogma1138
>The pill was already part of HIV trratment, it does nothing to change the
effectiveness of HIV tests.

Where is that stated?

>But: Anyone in that situation is already covered by the questions about
recent partners and already is not donating if answering the existing
questions in good faith. If they are donating in this situation at all they
are already just ignoring the questions.

I think you missed the entire point of the GP this isn’t about someone acting
in good faith or rationally.

------
dawhizkid
And yet STD rates are skyrocketing in the US. I take Truvada but it’s used as
an excuse in the gay commmunity to engage in unprotected sex. If anything the
availability of Truvada is probably a leading cause of why STD rates in the
gay community are increasing.

~~~
JumpCrisscross
> _STD rates are skyrocketing in the US_

Source? (If frequencies of curable STDs are rising while those of incurable
ones are falling, that would be a good trade.)

~~~
dawhizkid
Edit: common STDs that are treated by antibiotics are becoming drug resistant
like anything can be that is treated with antibiotics. Point is don’t think
because you can take an antibiotic and make syphilis go away now that you
won’t encounter a drug resistant strain now or in the very near future!

[https://www.nbcnews.com/news/amp/ncna642161](https://www.nbcnews.com/news/amp/ncna642161)

Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, genital
herpes, etc.

The recent year over year increase in STD rates in the US has been very well
documented.
[https://www.nbcnews.com/news/amp/ncna904311](https://www.nbcnews.com/news/amp/ncna904311)

~~~
denzil_correa
> Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, etc etc.

Each and everyone disease you listed here can be cured. Example, Syphilis -
[https://www.cdc.gov/std/syphilis/lab/default.htm](https://www.cdc.gov/std/syphilis/lab/default.htm)

~~~
hndamien
If you have a link for the genital herpes cure you will be rich.

~~~
uniblih
> If you have a link for the genital herpes cure you will be rich.

May never happen [0], but one can wish. Although it doesn't have a cure, the
treatability, prevalence, and general harmlessness of herpes make it less of
an issue than the "curable" STDs. Most doctors don't even bother testing for
it [1].

[0] [https://www.healthline.com/health-news/why-we-still-dont-
hav...](https://www.healthline.com/health-news/why-we-still-dont-have-a-
herpes-vaccine) [1]
[https://www.cdc.gov/std/herpes/screening.htm](https://www.cdc.gov/std/herpes/screening.htm)

~~~
masonic

      general harmlessness of herpes
    

Perhaps you missed that HSV is a vector for cancers (e.g Kaposi sarcoma).

~~~
esf
Kaposi Sarcoma is caused by HHV-8, a completely different virus than HSV-1/2\.
They are in the herpes virus family, but this is a huge virus group including
eg chicken pox (HHV-3) and Epstein Barr virus that causes mono (HHV-4).

------
jnaina
Honest question. The generics of Truvada are available in India for around
USD$30 a bottle from a number of local Indian Pharma companies including
Cipla. It would still be cheaper for Americans to travel to India on a budget
flight and buy back a year's supply of these generics. Wouldn't US immigration
allow importation of small amounts of medicine for personnel usage if you have
a doctor's prescription?

[https://dir.indiamart.com/search.mp?ss=tenvir-
EM](https://dir.indiamart.com/search.mp?ss=tenvir-EM)

~~~
adventured
There's a 50 dose limit, set by the Customs and Border Protection Agency when
bringing drugs back into the US, without a US prescription. There are some
exemptions for bringing prescriptions in from Canada and Mexico.

The FDA has its own rules, set at a three month supply, requiring a
prescription, and the drug must be legal in the US. You'll see conflicting
reports on whether you can get through customs with a three month
prescription.

For example here, from the FDA:

"Travel with no more than you need for your personal use during your stay. A
rule of thumb: Bring no more than a 90-day supply of medication."

[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.h...](https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.htm)

Does that apply only to foreigners, to US citizens, both? Who knows, their own
information across agencies seems conflicting and confused. They're probably
all unsure of which agency actually has final authority at this point, and or
they each probably think their agency does.

That said, every year millions of Americans bring in illegal prescriptions
regardless. If you're desperate enough and the savings is high enough, why not
try it within reason (stopping short of some large cache that gets you tagged
for smuggling that is).

------
tomatocracy
From what I've read previously, this isn't a surprise - PrEP is expected to
make a huge impact where it's available and this study sounds like it could be
very influential in getting it made available elsewhere which is, I think, its
real value - the public health effect rather than the individual-level effect.

The article linked below also details some of the pitfalls campaigners had to
overcome to get it funded on the NHS in the UK - the biggest hurdle was not
convincing people of effectiveness but that there was a need in the first
place - as safer sex is much cheaper but in practice just doesn't always
happen and we're probably at, or close to, the limit of what education can
achieve now.

[https://www.bbc.co.uk/news/stories-44606711](https://www.bbc.co.uk/news/stories-44606711)

------
stephengillie
Corroboration from a more reliable news source than Bloomberg:
[https://m.indiatimes.com/health/buzz/this-blue-pill-has-
been...](https://m.indiatimes.com/health/buzz/this-blue-pill-has-been-proving-
to-halt-the-spread-hiv-in-its-tracks-355092.html)

