Alarming surge in drug-resistant HIV uncovered • Hacker News Board

Re: Alarming surge in drug-resistant HIV uncovered

#111

Post by jdietrich » Thu, Aug 01, 2019, 12:11 PM UTC

DanBC wrote: post #101

rdl wrote: post #75

Earlier quoted context omitted.

Are you sure it actually cost your insurance $6k? Usually they have a high rack rate and negotiate down.

PrEP was pretty expensive. It cost the NHS about £5000 per year in 2017.

If I'm understanding correctly, t34543 was treated with PEP rather than PrEP; even with a relatively expensive drug combination (Truvada/raltegravir) this should cost about £850 at NHS tariff prices.

PrEP should be really cheap (~£10/mo) but the generic status of Truvada (emtricitabine and tenofovir) is being held up by legal shenanigans, so the NHS tariff price is currently £355.73/mo for the branded formulation. This has obviously severely constrained availability on the NHS, so a lot of at-risk individuals are just buying the generic online.

https://www.iwantprepnow.co.uk/

Re: Alarming surge in drug-resistant HIV uncovered

#112

Post by Geimfari » Thu, Aug 01, 2019, 12:14 PM UTC

rickycook wrote: post #17

Aloha wrote: post #14

Earlier quoted context omitted.

PrEP is hard to get, my doctor outright refused to prescribe it to me, they said they were not comfortable doing so

then get a new doctor. there is no medical rationale behind this, and they are letting irrational personal feelings get in the way of your good health

No that's not the case, the side effects of PrEP aren't minor. PrEP should not be prescribed so lightly.

Re: Alarming surge in drug-resistant HIV uncovered

#113

Post by [deleted] » Thu, Aug 01, 2019, 12:14 PM UTC

roel_v wrote: post #76

tuxxy wrote: post #3

This is why PrEP is so important and everyone at risk should be on it. We need to spread PrEP use as far and wide as possible.

I know nothing about this topic and I'll admit that I even had to google what 'PrEP' is, and I have a vague feeling I'm stepping into a minefield asking this question, but who is "everyone at risk" in this context?

[deleted]

Re: Alarming surge in drug-resistant HIV uncovered

#114

Post by quotemstr » Thu, Aug 01, 2019, 12:16 PM UTC

blablabla123 wrote: post #108

quotemstr wrote: post #104

Earlier quoted context omitted.

Unless PrEP succeeds in eradicating HIV (which might be possible if enough people are on it to limit the spread of the virus), it seems tailor-made to breed resistance. We don't generally give antibiotics prophylactically. Using anti-retrovirals this way seems like a bad idea from a drug resistance perspective.

I wonder if that's true though. I don't have a medicine background but I'm loosely following this development. I think the term drug resistance became popular with all these tuberculosis cases. What happened was that people got TB, they went to the doctor and got medicine. Then things got better and people felt healthy again so they stopped taking their medicine. BUT in reality they were supposed to take it for a lon…

Right. For resistance to evolve, some part of the treated population must survive. (You can't evolve resistance to atomic weapons dropped on your head.) Is PReP really effective enough to ensure that there are no survivors? Sure, maybe it is, used correctly at therapeutic doses.

What if it becomes common enough to get into the water at much lower doses? What if people split pills to reduce costs? ISTM that there are many potential avenues for evolving resistance.

Re: Alarming surge in drug-resistant HIV uncovered

#115

Post by galangalalgol » Thu, Aug 01, 2019, 12:17 PM UTC

vinni2 wrote: post #55

galangalalgol wrote: post #29

Earlier quoted context omitted.

yeah, shocking. if you have diabetes or a thyroid issue or hiv or really any chronic disease that requires medication you are out 12k a year easy, 6 for your insurance premiums and 6 for the deductible and copays. if you are broke there are some provisions, but if you are above the poverty line you gotta pay.

Is this true for health insurances paid by the employers too? I am just curious since people say if you have a tech job you have nothing to worry about healthcare in the US.

I have 20 years in c++ dev experience at an f500, in silicon valley I probably would get double the pay and full health benefits, but I probably would be too old to work there. so it depends on what you mean by tech.

Re: Alarming surge in drug-resistant HIV uncovered

#116

Post by Geimfari » Thu, Aug 01, 2019, 12:24 PM UTC

jimbob45 wrote: 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.

The drug has several non-minor side effects, is prohibitively expensive, and is the same as the treatment for someone who already has the virus. I for one think it's improper to prescribe a drug with these nephrological side effects to a large number of otherwise healthy individuals, not even accounting for the cost.

Re: Alarming surge in drug-resistant HIV uncovered

#117

Post by Geimfari » Thu, Aug 01, 2019, 12:28 PM UTC

roel_v wrote: post #76

tuxxy wrote: post #3

This is why PrEP is so important and everyone at risk should be on it. We need to spread PrEP use as far and wide as possible.

I know nothing about this topic and I'll admit that I even had to google what 'PrEP' is, and I have a vague feeling I'm stepping into a minefield asking this question, but who is "everyone at risk" in this context?

That would be men-who-have-sex-with-men, those with infected partners, sex workers, and intravenous drug users.

That is a fairly large number of the population that would be placed on an expensive drug with several side effects.

Re: Alarming surge in drug-resistant HIV uncovered

#118

Post by nerdjon » Thu, Aug 01, 2019, 12:47 PM UTC

Aloha wrote: post #14

jimbob45 wrote: 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.

PrEP is hard to get, my doctor outright refused to prescribe it to me, they said they were not comfortable doing so

Going to back up what the others said.

My husband and me both take prep, his first Doctor refused since it promoted "promiscuity" and would only prescribe it if you are in a relationship with someone positive.

Which is bull.

Find a new doctor that is actually sex positive and won't refuse it for stupid reasons.

(Admittedly I am lucky where I am though to have a doctors office that focuses on LGBT issues, which happens to include HIV prevention/care)

Re: Alarming surge in drug-resistant HIV uncovered

#119

Post by nerdjon » Thu, Aug 01, 2019, 12:52 PM UTC

Geimfari wrote: post #117

roel_v wrote: post #76

Earlier quoted context omitted.

I know nothing about this topic and I'll admit that I even had to google what 'PrEP' is, and I have a vague feeling I'm stepping into a minefield asking this question, but who is "everyone at risk" in this context?

That would be men-who-have-sex-with-men, those with infected partners, sex workers, and intravenous drug users. That is a fairly large number of the population that would be placed on an expensive drug with several side effects.

I would honestly just say anyone that is not in a monogamous relationship.

Straight men/women can easily have it and one fuckup and you can be infected

Re: Alarming surge in drug-resistant HIV uncovered

#120

Post by Nasrudith » Thu, Aug 01, 2019, 12:53 PM UTC

ben_w wrote: post #40

malandrew wrote: post #39

Earlier quoted context omitted.

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…

Pricing is always and inevitably what the market can bear, not anything about “fairness”. If prices are too high or communities are too poor (communities not countries), those communities go without. Right now, the US is so expensive that in cases like this it makes sense for patients to fly to another country to get the medicine. That’s unsustainable.

It fundamentally is about fairness albeit in a peripheral sense - the market doesn't exist in a vaccuum - those high prices depend upon granted monopoly rights and regimes which are a bargin wrongly conflated with property and treated like an entitlement instead of the contracts they are. Nothing is owned - only the ability to stop others from doing things. An unfair contract is increasingly likely to be ripped up because there is nothing more to be lost by doing so.

That people are flying abroad is the start of ripping up their local monopoly along with uncertifified online pharmacy importation and grey market sales - taking risks to avoid costs is a sign that the market /isn't/ bearing it.