A Blue Pill Is Stopping HIV, World-First Study Shows • Hacker News Board

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#11

Post by drewmassey » Sun, Oct 21, 2018, 8:41 PM UTC

matthewmacleod wrote: post #8

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 combinatio…

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.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#12

Post by DenisM » Sun, Oct 21, 2018, 8:50 PM UTC

tpetry wrote: post #6

DenisM wrote: post #4

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

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%.

It was $100k per course at the time of introduction in the US, which resulted in a lot of hate. But it is a miracle. A close relative of mine was cured, and it had a profound effect on her quality of life. Gilead has very different prices in different regions, we sourced from a place that was much cheaper.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#13

Post by thanatosmin » Sun, Oct 21, 2018, 8:59 PM UTC

akovaski wrote: post #5

Retric wrote: post #3

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

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...

Yep, look at Figure 1: https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018...

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

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#14

Post by metildaa » Sun, Oct 21, 2018, 8:59 PM UTC

drewmassey wrote: post #9

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.

In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#15

Post by dnsco » Sun, Oct 21, 2018, 9:01 PM UTC

drewmassey wrote: post #9

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.

Anecdotally, usage is highly regionalized, and is generally met with cultural resistance leading into exceptsnce per area. I started using it in San Francisco I’m 2013, before it was completely normalized. It has spread from major metropolitan centers and is going through the process of acceptance in smaller towns. A (somewhat sarcastic) call to put truvada in the municipal water supply is generally appreciated in the bay, but when I visit smaller mid-western cities these days there is still a lot of anti-prep sentiment. It has however achieved a reasonable amount of acceptance in regional hubs.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#16

Post by metildaa » Sun, Oct 21, 2018, 9:04 PM UTC

tptacek wrote: post #7

tpetry wrote: post #6

Earlier quoted context omitted.

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%.

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.

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.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#17

Post by metildaa » Sun, Oct 21, 2018, 9:08 PM UTC

drewmassey wrote: post #11

matthewmacleod wrote: post #8

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 combinatio…

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.

Even with insurance, the cost of essential drugs is too high. Our whole healthcare system consists of the care providers billing crazy, unjustifiable amounts to Insurance, followed by insurers paying out a percentage of that.

Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#18

Post by chimeracoder » Sun, Oct 21, 2018, 9:14 PM UTC

metildaa wrote: post #14

drewmassey wrote: post #9

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.

In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

> In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

This is wrong on so many levels.

Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts.

Secondly, Gilead (the manufacturer of PrEP) pays for the copay of the drug, up to a pretty high cap which is actually hard to reach under all non-catastrophic health insurances. That means that most people in the US who are on PrEP are eligible to pay literally $0 out-of-pocket. In other words, PrEP is literally cheaper for most Americans than it is for people in other countries, because every other country charges at least a nominal fee for the drug.

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#19

Post by chimeracoder » Sun, Oct 21, 2018, 9:18 PM UTC

matthewmacleod wrote: post #8

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 combinatio…

> 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.

The number is actually six, but given the number of people who've been taking PrEP since it was FDA-approved in 2012, that's still an impressive number.

The reason emtricitabine and tenofovir disoproxil fumarate work well together is because the primary known mutation that makes HIV resistant to the latter also increases its susceptibility to the former. There's a analogous situation in reverse with the primary mutation that provides resistance to emtricitabine.

PrEP is effective because strains of HIV that are resistant to both drugs are very rare, and also because most people who have resistant strains of HIV are on ARV treatment, which suppresses the viral load to the point where they cannot infect anyone else anyway (even without PrEP).

Re: A Blue Pill Is Stopping HIV, World-First Study Shows

#20

Post by chimeracoder » Sun, Oct 21, 2018, 9:22 PM UTC

drewmassey wrote: post #11

matthewmacleod wrote: post #8

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 combinatio…

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.

> 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).