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Alarming surge in drug-resistant HIV uncovered

nature.com

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Re: Alarming surge in drug-resistant HIV uncovered

#171

Post by bluGill »

drchewbacca wrote: post #72

Won't all drugs targeted at microbes fail eventually? Surely they create a strong selective pressure which favours the resistant strains. The wider and more frequently the drug is used the faster this process occurs?

That is a real worry in all areas where chemicals are used to selectively kill something undesired. It isn't just microbes, weed killers have the same problems. There is a real worry that in "a few years" (how long is not defined) antibiotics will cease to be useful and deaths will skyrocket from things we currently considered minor infections.

There is some hope though: having a resistant trait is only useful if it helps you survive. Most resistant traits are "costly" to keep around. Thus if we stop using some treatment - completely stop - in 100 years it will likely become useful again as those "microbs" without resistance out compete those with it.

Re: Alarming surge in drug-resistant HIV uncovered

#172

Post by magic_beans »

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

If you have the time to browse HN, you have the time to browser your health insurance website for a new doctor!

Re: Alarming surge in drug-resistant HIV uncovered

#173

Post by shawnz »

hcurtiss wrote: post #139
agentdrtran wrote: post #133

Earlier quoted context omitted.

Where did you go to med school?

What a snide reply. Is it necessary to be a doctor to have an opinion on healthcare policy?

Would you feel comfortable as a layman arguing with people who have been studying the topic for a decade about the tradeoffs involved?

Re: Alarming surge in drug-resistant HIV uncovered

#174

Post by bluGill »

jMyles wrote: post #167
zcid wrote: post #162

Why do we spend billions of dollars on a lifestyle disease instead of putting that money towards other concerns like cancer? Why does our society worry about a disease that is largely the result of poor choices over other ailments that are solely due to bad luck? We spend far more on HIV research than any other single disease: https://report.nih.gov/categorical_spending.aspx

Your message seems, at least to me, to be quite judgmental. I'm interested in helping people who make bad choices and people who have bad luck. It's not clear to me that one group deserves more compassion than the other. The comparison to cancers is a bit odd - HIV is generally not regarded as a lifestyle disease, while of course many cancers do have a lifestyle component. HIV is communicable; the time and money spen…

I find it odd that HIV is not a lifestyle disease. Everything I know about it says that someone is at zero risk if they take lifestyle precautions. Is there some risk to someone who doesn't do drugs and is in a monogamous relationship? That is they might catch it from someone near them (like the flu from a cough). Or is the definition of lifestyle disease different from what I intuitively think it is, so HIV doesn't qualify.

I'm with you on helping people who have made bad choices. However I do agree with the poster above: HIV seems to be getting an out sized share of research compared to other things that kill more people.

Re: Alarming surge in drug-resistant HIV uncovered

#175

Post by word-reader »

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

You can get it prescribed online. I think you just video chat with a doctor, then they prescribe. Plushcare and Nurx are 2 sites I found just by searching.

Re: Alarming surge in drug-resistant HIV uncovered

#176

Post by LargeWu »

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.

The reason markets don't really work well for healthcare is that 2 things efficient markets require are competition and symmetrical information. Drug companies have exclusive patents. Doctors require extensive licensing that limits the labor supply. Prices are not transparent from providers. And maybe most importantly, in many cases people don't really have a choice whether they want to participate in the market or not; it's sometimes a choice of "pay whatever they say for treatment" and "die".

Re: Alarming surge in drug-resistant HIV uncovered

#177

Post by word-reader »

stickfigure wrote: post #48
ohyeshedid wrote: post #13

Earlier quoted context omitted.

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…

In developed countries most HIV transmission is due to anal sex between men who have sex with men, where the odds of transmission per single act are more like 1 in 30. The transmission is much more heterosexual in Africa however, where most of this resistance is happening. [1] I'm kind of confused about the sexual practices that could cause this to happen, but I'm sure prostitution and rape (which increases transmission odds due to trauma) are involved.

[1] https://www.healthline.com/health/hiv-aids/rate-global-diagn...

Re: Alarming surge in drug-resistant HIV uncovered

#178

Post by stickfigure »

mozey wrote: post #52
stickfigure wrote: post #48

Earlier quoted context omitted.

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…

What is your source for the 1 in 500? The numbers I found on the same website indicate an even smaller risk https://www.catie.ca/en/pif/summer-2012/putting-number-it-ri... However, "As you can imagine, accurately tracking the number of times a person is exposed to HIV is very difficult".

I don't recall; the numbers on Catie (~1 in 1250) are more modern and certainly a better estimate.

Either way, you only have to add a few more digits of risk mitigation and you're more likely to die in a car accident. A test that had even a 1% false negative rate would cover most of that ground.

Re: Alarming surge in drug-resistant HIV uncovered

#179

Post by nness »

notyourday wrote: post #94
nness wrote: post #90

Earlier quoted context omitted.

I don't follow your comment; The drug is intended for those people at risk of contracting the disease. Why would you take PrEP if you weren't at risk? (Your also discounting drug users; but unfortunately those addicted and at risk are also the least likely to have the means to acquire the drug.)

It is not about who the drug is being intended for -- it is about who the drug is being marketed to. For example there's a massive campaign targeting both men and women engaging in any sort of sexual activity that includes fluid exchange promoting usage of PrEP. One can see it in a subway and on local commercials on TV.

Assuming in the US? (can't think of another market where prescription drug marketing is unrestricted)

Re: Alarming surge in drug-resistant HIV uncovered

#180

Post by MaupitiBlue »

agentdrtran wrote: post #135
wtdata wrote: post #129

PrEP has negative side effects (besides being quite expensive for the state), condoms on the other side, don't have side effects, and are cheap. It's a matter of having some sense of personal responsibility really.

> It's a matter of having some sense of personal responsibility really. This exact phrase was used to spin the deaths of thousands of gay men as a personal failing not many years ago. Stop doing it.

It is a matter of personal responsibility. Just like obesity, smoking, and often type 2 diabetes.
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