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Alarming surge in drug-resistant HIV uncovered

nature.com

41–50 of 237 posts

Re: Alarming surge in drug-resistant HIV uncovered

#41
post #22

Probably because homosexuality doesn't fit their 19th century worldview

Or some people take it and engage in risky sexual behavior because they're now on it. I know more than a few people like that. Not everyone is a backwards hick, you're just virtue signalling.

But that's a society problem, not an individual issue. If someone requests protection from HIV, that's a serious problem for them. Other STIs you can cure, or are not as dangerous in effects.

Re: Alarming surge in drug-resistant HIV uncovered

#42

Earlier quoted context omitted.

I can confirm in the US it is truly that expensive (which is fucking crazy). I have pretty good insurance (or at least the best I can get self-buying) but I still have to pay 30% of meds costs. That is something like $400 /month. Luckily Gilled will reimburse up to 7500 /year. Fucked up private insurance in US, they charge that much and then do the reimbursement so they can bill the huge monthly cost to plans / gover…

In the US, we’re paying obscene prices because no other country pays their fair share to recoup the cost of development plus bringing the drug to market plus a reasonable margin for the effort. The US should establish an agreement whereby US patients pay a LOT less but that the foreign patients need to pay the same. The amount the industry earns should be low enough to make it reasonably financially accessible to pat…

> During the quarter [2019 Q2], Gilead generated $2.2 billion in operating cash flow, repaid $500 million of debt, made dividend payout of $800 million and spent $588 million on share buybacks.

> Adjusted product gross margin was 87.3% compared with 84.2% in the year-ago period. Research & development (R&D) expenses were relatively flat at $916 million. Selling, general and administrative (SG&A) expenses increased 20.8% to $1.01 billion.

https://finance.yahoo.com/news/gilead-gild-q2-earnings-sales...

They’re doing OK, I think.

Re: Alarming surge in drug-resistant HIV uncovered

#43
post #32
post #5

Earlier quoted context omitted.

It’s insane that it is $1400/month out of pocket, and if you have a high deductible plan you’d still be paying $6k+ potentially before it’s covered.

I've checked and it's € 50 a month in the Netherlands for the pills. There is something else going on with that pricing. There are doctor fees on top of that, but a few checks a year will never consitute the $15k difference.

Starting today in NL is a subsidized program for at risk MSM via the GGD. Participants pay 7.50 per 30 pills.

Re: Alarming surge in drug-resistant HIV uncovered

#45
post #5
post #2

Well, PrEP is a miracle drug that has gone criminally underutilized in the fight to eradicate HIV. It would be nice to see governments really push it hard for a change.

It’s insane that it is $1400/month out of pocket, and if you have a high deductible plan you’d still be paying $6k+ potentially before it’s covered.

Perhaps more countries should follow Thailand's approach:

    On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require 
    manufacturers to license generic versions of their patented drugs–for two Western medicines: 
    Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning 
    treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis and U.S. 
    firm Bristol-Myers Squibb. These attacks were preceded in November 2006 by a violation of 
    Merck’s patent on the anti-AIDS drug Stocrin.[5] The government threatened to break 
    patents on eleven more drugs.[6] Explaining the rationale behind Thailand’s decision, health 
    minister Mongkol Na Songkhla said that “the move is permissible under international trade 
    rules in the event of national public health emergencies. . . . We have to do this because we 
    don’t have enough money to buy safe and necessary drugs for the people under the government’s 
    universal health scheme.”[7]
Source: http://www.aei.org/publication/thailand-and-the-drug-patent-...

Perhaps "evergreening" is also an issue in the USA that might keep prices high for a long time?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680578/

Re: Alarming surge in drug-resistant HIV uncovered

#46
post #15

#What -- In several geographically distant third world countries HIV is becoming antiretroviral resistant in ~10% of cases. #Why -- No one is _really_ sure. The most popular hypothesis is that it happens when people go on and off the medicine. Why would people do this? Shame, access, and some mothers that went on only during pregnancy. WHO recommended a pregnancy only treatment until ~2015. #Impact -- These resistant…

Well, to be more clear on the #what: These are strains resistant specifically to efavirenz and nevirapine.

Both drugs are members of the same class of anti-retrovirals, NNRTIs, which aren't prescribed together, they are two alternatives of the same type of drug and are used in combination with other drug classes.

None of the people have resistance to anti-retrovirals in general, they have resistance to a particular class which is no longer recommended in the US (as a first treatment) but is still a go-to in Africa. There are multiple other drug classes that can be put together for effective treatment.

In the US, Efavirenz (brand name Sustiva) used to be one of the first-line recommendations, but has been replaced by other drugs with fewer side effects and higher barriers to resistance.

Importantly, no currently recommended starting regimens contain a member of the NNRTI class.

All 4 of the current US recommended regimens now contain an integrase inhibitor (Dolutegravir, Bictegravir, or Raltegravir)

https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-a...

The integrase inhibitors have exceptionally few side effects and are also very high barrier to resistance. Dolutegravir which is mentioned at the end of the article is especially good in this regard, to the point that it is the only drug currently used in an only 2 drug (vs 3 drug) combination therapy. The main thing that needs to happen is for these areas to transition off of these particular NNRTIs.

Re: Alarming surge in drug-resistant HIV uncovered

#48
post #10

I always felt like the only way you can eliminate the spread of a highly adaptive std is to develop a low barrier on-the-spot test administered just before intercourse at the latest or some point reasonably earlier in a date or whatever. This would still fail under the dormancy period viruses assume but it should improve the odds I'd imagine for those connected in one way or another to promiscuous sexual networks.

That's not a bad idea, but how does liability play out on a defective test, or a test used in a manner other than directed? Would you bet the rest of your life on a casual test like that?

Maybe?

HIV transmission is not so easy; last I checked, the rough odds of transmission from a single act of unprotected vaginal sex with a HIV+ partner was around 1 in 500.

If the test is 99% accurate, and your partner isn't in an obvious high risk group, it may push the odds into "less risky than other behaviors you commonly accept" territory.

For point of reference, condom use only decreases the risk by a factor of 10. Possibly less: https://www.catie.ca/en/fact-sheets/prevention/condoms

Re: Alarming surge in drug-resistant HIV uncovered

#49
post #45
post #5

Earlier quoted context omitted.

It’s insane that it is $1400/month out of pocket, and if you have a high deductible plan you’d still be paying $6k+ potentially before it’s covered.

Perhaps more countries should follow Thailand's approach: On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require manufacturers to license generic versions of their patented drugs–for two Western medicines: Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis…

Quoting like this makes it impossible to read on mobile. Not your fault but “speech marks” are fine.

Re: Alarming surge in drug-resistant HIV uncovered

#50
post #5
post #2

Well, PrEP is a miracle drug that has gone criminally underutilized in the fight to eradicate HIV. It would be nice to see governments really push it hard for a change.

It’s insane that it is $1400/month out of pocket, and if you have a high deductible plan you’d still be paying $6k+ potentially before it’s covered.

That's insane. In Kenya, PrEP is offered free of charge in all public hospitals while in private hospitals, brand name drugs will set you back about $35, while generic equivalents cost about $4.
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