Study: AIDS pill helps gay men avoid HIV infection
 

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I really want to know how this works. The article says it's a major advance for gay/bisexual men, but would not apply to M-F couples and needle users. What exactly is this pill doing?

I'm confused on how it would not work for m-f couples?

Hmmm perhaps due to the method of transmission?

Unless they're deciding that "ZOMG teh gay" is some sort of genetic defect here (oh my that will go oh so well).

AFAIK it's because it hasn't been tested on them. Later they say that they've used HIV treatment to prevent infection before in pregnant women and people inadvertently exposed to infected bodily fluid like hospital employees pricked by an improperly disposed of sharp.

It's a bit like the HPV vaccine not being available for men despite the fact that it would work just fine in them.

I can see that with IV drug users, but not with M-F couples.

That makes sense, but I still want to know what kind of pill would be useful for one orientation but not another. It's not as if the virus can detect whether or not someone is a homosexual, you know?

I'd be interested in seeing the remaining studies when they're completed.

But the transmission is slightly different as it's usually due to anal sex. It's much harder for men and women to get the virus via PiV sex.

So that's why it didn't necessarily say straight couples, but M-F couples. It's not the orientation that matters but the transmission vector.

I think it's just saying they are studying the effects on M-F partners and needle users, and don't have a conclusion yet. But they did the study on gay men first, and have a result. Could be the pill "may" work for needle users and M-F partners as well, they just can't say yet. Note it's not a miracle pill, but most effective when coupled with condoms, counseling, etc.

I think this is disturbing. "As a practical matter, price could limit use. The pills cost from $5,000 to $14,000 a year in the United States, but only 39 cents a day in some poor countries where they are sold in generic form."

Got it. Thanks for the extra info.

Yes. This.

This is the most important part of the study:

Daily doses of Truvada cut the risk of infection by 44 percent when given with condoms, counseling and other prevention services.

In other words, don't follow the white rabbit down the hole and think there's now a pill that says it's okay to carelessly go raw dawg and drop loads in 'em. That goes for all anal couples (gay and hetero). Mmmmkay!? Thanks.

I feel compelled to clarify that "much harder" doesn't really mean incredibly difficult, just that there are less likely to be entries into the bloodstream at any given time.


And honestly between the cost - no insurance company will pay for this as a long term preventative - and the overall lack of reliability, I don't see this getting used except as a 'morning after' pill should people find out their partner is positive following sex.

It's good that the pill is so much cheaper outside of the US, but it's probably needed far more for treatment there. And particularly women in those countries are the most vulnerable, so more testing needs to be done to give them access.

Yea, I get that it's still being tested. I was just trying to wrap my mind around what the pill itself does. It goes without saying that it needs to be coupled with other protective measures, but I'm just trying to figure out what the pill is doing for it to work in gay/bisexual men but possibly not in M-F couples.

Ex. If it's attacking the virus, that shouldn't be exclusive to one orientation group (I know this isn't the case, since this is to be a preventative measure, but that's what my thought process is).

I don't think a whole lot of people will use the pill, either because of lack of access or perceived lack of effectiveness.

Unfortunately, I do think that some people will take this to mean that there are "quick fix" preventive measures and perhaps even a "cure" down the road. That can lead to carelessness because humans tend to be careless when they believe something may become foolproof.

Yep - we should all remember that you have to be REALLY careful publishing results, particularly before peer review. If it were only tested in a certain area, that's all we can say (even if it likely has effects in other areas).

We should also remember that peer review "reverses" a relatively large number of niche findings like this.

Also important to keep in mind - causation/correlation and all that.

Viruses are still one of the greatest challenges to human health, even though we've made exponential improvements just in the last decade or so. It's really encouraging, though, that treatments are being proven effective and finding new (and equally vital) uses. Now, if the cost could come down, we'd be in business.

I appreciate the visual this early in the afternoon lol

Understood. I inadvertently used M-F to mean "straight" in my mind. I get that there's a higher risk because of the way intercourse takes place.

I think in general, preventative treatment stimulates the person's immune system in advance of infection. Then if the virus is actually introduced there's a chance that the body can actually fight it off before it gets a toehold. Although the same effects might occur in all people, it might not cause as great of a decrease in drug users or M-F couples due to the infection vector. So it might be equally effective but only cause a 15% reduction thus making it less desirable for M-F couples to take.

Follow the mucus membranes.

Women are at much higher risk than men during vaginal intercourse (oversimplification alert!), and anal intercourse has higher incidence of infection than both.

Yep - it's actually a "utility" thing, especially compared to expense.

As you noted earlier, the comparison w/ HPV becomes apt at exactly this point: dudes could get the vaccine, but most male HPV infections have very few severe effects, especially in comparison with cervical cancers etc.

I was wondering if somebody was actually gonna catch that.

Doesn't sound so wonderful.

Yes!

I heard about it on NPR a little while ago, and they priced it at $30 a day. 39 cents versus $30? Wow.

Name brand vs. generic

I know...it just bothers me how much they can charge. Out of the three medications I take two have generics, and they cost me $30 together. The third does not yet and costs $70. And none of those are medications which prevent a life threatening illness.

Entirely different topic^, I just feel like ranting every time drug companies come up.

It is way overpriced. I only use generics.

I also have kind medical professionals who give me enough samples to last for a while. They know those prescriptions are overpriced even with health insurance.

I have no current alternative to the $70 medication, and I do need it. It's just frustrating to see the two others combined cost less than half of what that one does. (And this is all with good insurance as I'm on my parents' plan). The only times I get samples are when my doctor has them, and it's never a month's worth. I want to rant every time I go to the pharmacy.

Or, more specifically, "Patented vs. patent-expired" ... it sucks, but it's the cost of doing business as far as encouraging corporate-sponsored research. The deal with the devil, so to speak.

However, promoting it for men not only helps prevent penile cancer but also reduces the infection rate in women. Herd immunity at its finest. Also since it covers several of the strains that cause genital warts it isn't a bad idea to get the shot regardless of sex.

But while i'm still working on getting the HPV vaccine - insurance kicks in Dec 1st. Whoohoo! - I'm not going to start taking preventative HIV medication because the risks and likely the utility is just not the same.

I was cheered a bit to see an article state the rates of infection were slowing worldwide. Maybe some of the education is getting through.

Also companies may have deals with certain countries that provide anti-HIV or anti-malarial etc. drugs for far cheaper than they do elsewhere due to dire need. And over here, insurance companies subsidize it so the true cost is not always as apparent. $Cost is not the same as $AmountPaid.

I totally agree with you here, in the abstract, but also see why men are a much lower priority (for once) - particularly w/re/to Herd Immunity.

Yes, it was good that they studied women first, but now they're proceeding with the study for men and I suspect it will be improved for them as well. Since M-F sexual encounters are the most common it makes a lot of sense to innoculate the "carriers" (that is, men) as well as the women. :p

Similarly since gay men are still at the biggest risk - though not the fastest increasing risk - for HIV it makes sense that they were the target population here as well.

If you read the actual study, the patients that actually took the medication as directed (didn't skip doses) and used condoms, decreased their risk by 99%. The 44% included "intent to treat" which means all the patients who signed up but didn't take the medications because they forgot, dropped out because of medication side effects, took medications intermittently, didn't use condoms, etc.

As for the disclaimer for IV drug abusers and M-F sex, since they have active studies looking at these groups, they can't comment on whether this drug is effective in these groups. Obviously gay males will be at higher risk than M-F patients with partners infected with HIV, but the risk of side effects for the drug itself makes the question different. IV drug abusers have a different infection model that doesn't apply to this study, and it would be irresponsible to assume that the results would be the same.