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Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

nytimes.com

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Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#31

Post by matthewmacleod »

VeryAnonymous wrote: post #26
aussieguy1234 wrote: post #8

There is already prep, a once a day pill that if taken consistently, is over 95% effective at stopping HIV infection, I've heard some sources say it's 100% effective. While it's not medically considered to be a vaccine, most vaccines for other conditions have a lower effectiveness rate. There is work being done to turn prep into an injectable chip in the arm, like long term contraceptives, but for HIV prevention.

The thing that worries me about antiretroviral drugs is that they mess with mechanisms that are innate to the reproduction of cells. Their effects can, e.g., be clearly seen in changes to the bone marrow, which IIRC has some of the fastest-reproducing cells in the human body. We don't have long-term data yet on what this does to users of this drug. My wife has to take such drugs as she has HIV, and I wouldn't be surp…

It's true that there are definitely some side-effects and we'll need to wait and see what the long-term consequences are. The good news is that they at least appear to be well-tolerated drugs, and newer drugs show fewer adverse effects - minor bone-density reduction and renal function impact are the main adverse effects of Tenofovir + Emtricitabine, with no obvious effect on bone marrow for example.

But it's quite a tricky decision to make. Vaccines aren't without risk either, though adverse reactions are also rare. Certainly from a cost perspective, PReP with high efficiency makes a lot of sense – lifetime treatment and monitoring of an HIV+ patient can be markedly more expensive than a relatively cheap preventative medication, especially in high-risk groups.

I have been beating around the idea of taking PReP for a while, what with being part of a higher-risk group in an area with relatively high HIV prevalence. It's definitely a harder commitment to make than vaccination is, but I hope that we can improve our knowledge and understanding of the risks as the trials currently underway progress.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#32

Post by leoc »

FabHK wrote: post #22
hannob wrote: post #11

Given what I learned in recent years about the scientific process I'm always a bit wary of making this a "spend XXX money to get YYY results". We have issues like that still a sizable amount of medical studies are unpublished because they don't produce the desired result the funder wants, that experts think a vast amount of studies are simply research waste due to poor methodology or that the majority of pre-clinical…

> don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results. Most typically, to make studies methodologically stronger, you require a bigger sample, ie more subjects, to increase power while maintaining or even improving significance. And that would make it more expensive.

But it's uncertain whether simply pouring more money into the funding hopper would generally result in studies with larger sample sizes, or whether it would just result in a larger number of surveys with a sample size similar to the deficient ones we see today, as a larger number of scientists manage to cling by their fingertips to the gravy train. After all, there's presumably little good reason why we couldn't have fewer but better studies today, at existing funding levels.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#33

Post by Broken_Hippo »

leoc wrote: post #32
FabHK wrote: post #22

Earlier quoted context omitted.

> don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results. Most typically, to make studies methodologically stronger, you require a bigger sample, ie more subjects, to increase power while maintaining or even improving significance. And that would make it more expensive.

But it's uncertain whether simply pouring more money into the funding hopper would generally result in studies with larger sample sizes, or whether it would just result in a larger number of surveys with a sample size similar to the deficient ones we see today, as a larger number of scientists manage to cling by their fingertips to the gravy train. After all, there's presumably little good reason why we couldn't have…

You could be reasonable and make larger sample sizes and so on requirements.

While it isn't certain that simply pouring money into funding hoppers results in more studies, it is pretty certain that larger sample sizes (and things like this) cost more money. It is prudent to give enough for these things.

If you want to have more accountability with money, build it in. You might find it costs more or less than current funding levels - I'm going to guess costs will vary with sort of funding. Use equipment funds for equipment. Give researchers and their staff actual, decent, steady wages not reliant on results. (A "negative" result isn't negative, after all, for it disproves something).

And so on.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#34

Post by shard972 »

rdl wrote: post #25

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#35

Post by close04 »

shard972 wrote: post #34
rdl wrote: post #25

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....

Sure, because HIV through heterosexual sexual relations, needles, mother to child, and other types of bodily fluids exchange definitely aren't a thing. Let's go back 3 decades and call AIDS "GRID" again.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#36

Post by Brakenshire »

FabHK wrote: post #22
hannob wrote: post #11

Given what I learned in recent years about the scientific process I'm always a bit wary of making this a "spend XXX money to get YYY results". We have issues like that still a sizable amount of medical studies are unpublished because they don't produce the desired result the funder wants, that experts think a vast amount of studies are simply research waste due to poor methodology or that the majority of pre-clinical…

> don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results. Most typically, to make studies methodologically stronger, you require a bigger sample, ie more subjects, to increase power while maintaining or even improving significance. And that would make it more expensive.

I spoke to a medical researcher who had worked both in public and private labs during their career, they said when they worked in public academic labs there was incompetence to the extent that no-one understood how to properly calibrate certain lab equipment. Working in private research, they said public research generally could not be replicated, and unless from a known lab was considered borderline useless.

I think it goes way beyond what you’re talking about. In large sections of academia there’s a very Darwinian system where researchers are fighting for their careers and labs are trying to keep their heads above the water, and everyone needs sexy results now. I don’t think such a system can lead to robust, unbiased research by default.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#37

Post by jayalpha »

rdl wrote: post #25

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

This are some amazing buzz words your have learned.

"Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it."

Probably. And to throw a mutagenic chain reaction against evolutionary pressure, what possibly could go wrong? And why does this not work in the lab and why do mosquitoes develop resistance against gene drive after a few generations?

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#38

Post by rdl »

shard972 wrote: post #34
rdl wrote: post #25

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....

Even if AIDS went away overnight, there would still be a whole range of other diseases spread particularly through male homosexual sex, IV drug use, and high-partner count or professional sex. I wonder at what point hepatitis actually becomes more of a problem in rich first world cities than HIV.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#39

Post by kadendogthing »

shard972 wrote: post #34
rdl wrote: post #25

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....

There are more heterosexuals with HIV than homosexuals.

Re: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

#40

Post by kadendogthing »

rdl wrote: post #38
shard972 wrote: post #34

Earlier quoted context omitted.

We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....

Even if AIDS went away overnight, there would still be a whole range of other diseases spread particularly through male homosexual sex, IV drug use, and high-partner count or professional sex. I wonder at what point hepatitis actually becomes more of a problem in rich first world cities than HIV.

>there would still be a whole range of other diseases spread particularly through male homosexual sex

Like what?

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