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

Re: Alarming surge in drug-resistant HIV uncovered

#61

Post by matthewmacleod » Thu, Aug 01, 2019, 7:57 AM UTC

gleb wrote: post #24

bsagdiyev wrote: post #23

Earlier quoted context omitted.

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.

UpToDate.com: STI incidence among MSM using PrEP Men who have sex with men (MSM), particularly those who have indications for pre-exposure prophylaxis against HIV (PrEP), are at high risk for sexually transmitted infections (STI). In a study of nearly 3000 MSM in Australia who were initiating PrEP, the incidence of new chlamydia, gonorrhea, or syphilis over the subsequent year was 92 cases per 100 person-years [2]. N…

We should remember though that what this demonstrates is a high correlation between PrEP use and risky sexual behaviour. It does not suggest that PrEP use encourages that behaviour - I don’t doubt that in some cases it does, but it’s difficult to think it does so generally.

Re: Alarming surge in drug-resistant HIV uncovered

#62

Post by DanBC » Thu, Aug 01, 2019, 8:06 AM UTC

jxramos wrote: 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.

A test exists. It's good but not perfect. If you have the disease it will return positive 99% of the time. If you do not have the disease it will return positive about 1% of the time. About 0.1% of the population has the disease. You take the test. It returns positive.

What are the chances you have the disease?

People on HN may be able to work this out, but I guarantee that many people (including doctors and nurses) can't.

See Gerd Gigerenzer's work on this in Reckoning With Risk or Risk Savvy.

Re: Alarming surge in drug-resistant HIV uncovered

#63

Post by ChrisRR » Thu, Aug 01, 2019, 8:09 AM UTC

rusticpenn wrote: post #44

Actually going on and off medicene is one of the ways of fighting HIV as the less robust strain kills the more robust strain and then the medicene is more effective...

Do you have a source for that?

Re: Alarming surge in drug-resistant HIV uncovered

#64

Post by DanBC » Thu, Aug 01, 2019, 8:10 AM UTC

DanBC wrote: post #62

jxramos wrote: 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.

A test exists. It's good but not perfect. If you have the disease it will return positive 99% of the time. If you do not have the disease it will return positive about 1% of the time. About 0.1% of the population has the disease. You take the test. It returns positive. What are the chances you have the disease? People on HN may be able to work this out, but I guarantee that many people (including doctors and nurses)…

We can re-word this to make it easier.

1000 people take a test. 1 of them has a disease, and the test will probably return positive for that person. 999 of them do not have the disease, and the test will return positive for about 9 of them.

Re: Alarming surge in drug-resistant HIV uncovered

#65

Post by ChrisRR » Thu, Aug 01, 2019, 8:12 AM UTC

mm202018 wrote: post #5

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.

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 the UK the NHS doesn't supply it yet, and GPs won't officially recommend it. But you'll find the NHS clinics quite often recommending prep purchase through international websites and referring you to HIV charities.

It costs about £30 pm in that case which is about $40

Often they'll be running studies at the same time to assess the feasibility of Prep on the NHS.

Re: Alarming surge in drug-resistant HIV uncovered

#66

Post by [deleted] » Thu, Aug 01, 2019, 8:22 AM UTC

malandrew wrote: post #39

dillondoyle wrote: post #35

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…

[deleted]

Re: Alarming surge in drug-resistant HIV uncovered

#67

Post by StreamBright » Thu, Aug 01, 2019, 8:41 AM UTC

malandrew wrote: post #39

dillondoyle wrote: post #35

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…

You are paying this much because of many reasons non of them is why the rest of the world does not pay its fair share.

https://www.investopedia.com/articles/personal-finance/08061...

Re: Alarming surge in drug-resistant HIV uncovered

#68

Post by dang » Thu, Aug 01, 2019, 8:42 AM UTC

himlion wrote: post #22

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

This comment breaks the site guidelines. Would you reviewing them and sticking to them when posting to HN? They include:

"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."

and "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."

https://news.ycombinator.com/newsguidelines.html

We detached this subthread from https://news.ycombinator.com/item?id=20580974.

Re: Alarming surge in drug-resistant HIV uncovered

#69

Post by dang » Thu, Aug 01, 2019, 8:43 AM UTC

bsagdiyev wrote: post #23

himlion wrote: 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.

Please don't respond to a bad comment with a personal attack. That only makes this place even worse.

https://news.ycombinator.com/newsguidelines.html

Re: Alarming surge in drug-resistant HIV uncovered

#70

Post by tallanvor » Thu, Aug 01, 2019, 8:46 AM UTC

matthewmacleod wrote: post #61

gleb wrote: post #24

Earlier quoted context omitted.

UpToDate.com: STI incidence among MSM using PrEP Men who have sex with men (MSM), particularly those who have indications for pre-exposure prophylaxis against HIV (PrEP), are at high risk for sexually transmitted infections (STI). In a study of nearly 3000 MSM in Australia who were initiating PrEP, the incidence of new chlamydia, gonorrhea, or syphilis over the subsequent year was 92 cases per 100 person-years [2]. N…

We should remember though that what this demonstrates is a high correlation between PrEP use and risky sexual behaviour. It does not suggest that PrEP use encourages that behaviour - I don’t doubt that in some cases it does, but it’s difficult to think it does so generally.

Honestly, if you ask just about anyone in the community you'll find the general agreement is that PrEP does result in the decreased use of condoms, so it's not surprising that there is a general increase of other STDs.

But as more people start using PrEP and get tested regularly due to the general requirements, it is possible that STD rates will decline, but we're probably a few years away from seeing that in the statistics.