Truvada in today's NYT

[Newly]

There's a very interesting article on the HIV prevention properties of Truvada in today's NYT. I'm sure this has been discussed here before and I apologize if this is old news but the article seems to be saying that just using this on a daily basis is almost as effective as using condoms to prevent transmission of HIV. As someone who grew up during the epidemic it seems hard to believe that maybe barebacking is no longer a death wish if you take this medication? Maybe I'm not quite understanding it, but I was also amazed at how few gay men seem to be using it. It's expensive, but if I were in a high risk occupation such as escorting it would seem like a no brainer, along with hepatitis a and b vaccinations.

[Str8boyluvr]

As someone who grew up during the epidemic it seems hard to believe that maybe barebacking is no longer a death wish if you take this medication?

 

I would not take that perspective at all with regards to any PrEP drugs.

 

Bare-backing is and will remain a potential death wish when it comes to HIV. I have studied and done coursework on the HIV virus for academia and the pharmaceutical industry for some time. While it remains the most studied virus in the history of mankind, there is much we still do not know. For such a small virus, it is amazingly complex, evasive, and innovative.

 

As for the NYT article or any similar article, I would challenge you to go back and research the sources, quotes and data they cited on your own. I think you will find, especially if the article was written by a non-science person, many factual errors, omissions or misrepresentations. Sometimes even a hidden agenda in support of a particular group.

 

PubMed and Google Scholar are great sources for debunking such articles to see what is true and what is in error. If you run up against any papers that require a subscription or payment, I'm happy to try and get you a free copy from my University.

[adannyboy]

I would not take that perspective at all with regards to any PrEP drugs.

 

Bare-backing is and will remain a potential death wish when it comes to HIV.

 

Definitely. That's the worry with some of this, isn't it? That guys will become more lax with their sexual practices?

 

On the other side of that, that's what they say about birth control for women. That they'll just go sluttin it up around town.

 

I'm still on the fence about PrEP. I plan to talk to my doc about it at my physical next month.

 

I know some that are still weary that the same medication is prescribed for prevention AND treatment and are skeptical that that is an big pharma industry-driven "conspiracy" if you will since Truvada is a HUGE money maker for Gilead.

 

As far as coverage, on my health plan it's still $150/mo.

 

D

[corndog]

Ever since PrEP was first discussed, it's been controversial because of fears that people would use it instead of condoms and not in addition to condoms. Reputable public health authorities have advocated PrEP only as an additional level of protection, never as a replacement for safer sex practices.

[Phil_musc]

Well yes, but no less a source than NPR just recently did a feature on zero-discordant couples in Africa who were using some form of PrEP as a means of keeping the status quo in their relationship. There seems to be mounting evidence that this will be the wave of the future in the fight against HIV infection. It also appears that others in the porn industry (Michael Lucas for one) are beginning to think along these lines that infection is not likely between partners if both sides of the equation are on some form of PrEP protocol. As a person who lived through the horrors of the early days of AIDS and HIV I am skeptical but optimistic that this will in fact be the end of HIV sometime in the relatively near future.

[+ Gar1eth]

And I am just waiting (unhappily) for the HIV virus to mutate and become resistant to Truvada from people not taking it daily as it is meant to be taken. In my admittedly limited view, it should be used along with comdoms to cut the risk of infection even lower with condom use.

 

Gman

[Newly]

I wasn't suggesting that anyone take risks based on one newspaper article, I assume that anyone on this board has the intellectual capacity to take it for what it is. Nonetheless it is an interesting discussion as to alternatives to combat a real health threat. As Danny pointed out it is the attitude of unfailing trust in a system that has its own agenda that can lead to a lot of needless suffering. Somewhat like a nutritionist saying that eating beef would solve India's need for protein. Like it or not lots of people refuse to use condoms and anything that can help that population is important. Who knows what the future holds for aids, but with drugs like Truvada and the discovery of certain genes that inhibit its transmission in the next few years it's possible that it will be regulated (at least in the developed countries) to the same dust bin that polio and smallpox are in. Gman, I understand what you're saying, but different people have different levels of risk aversion, if you really want to avoid risk stop having sex, but based on the board we're on I don't think that's a real likelihood. If it is shown that drugs can reduce the risk to 97.99 percent while condom use reduces it to 98% and using both reduces it to 98.5% I can certainly understand how many people may be willing to take the additional risk while those who are risk averse may prefer not to. Happy New Years by the way.

[Guest]

Rather than getting medical information from newspapers, I would advise seeing what the CDC or other reputable national organizations say about this. This is the CDC's statement:

http://www.cdc.gov/hiv/prevention/research/prep/

 

According to them, among those who were faithful in taking the medication, in one study....

Participants in the TDF/FTC group with detectable levels of the medication experienced a 90 percent reduction in risk for HIV infection; in the tenofovir- only group, the presence of medication in the blood was associated with an 86 percent reduction in risk. CDC co-managed two of the nine sites for this study.

 

In another study Consistent with prior research, participants who took the medication consistently had higher levels of protection. In an analysis of participants known to be adherent because they were observed taking their medication and had tenofovir detected in their blood, the risk of HIV acquisition was reduced by approximately 74 percent.

 

While certainly a decent level of protection, I'm not sure I'm comfortable with even 90% when something this serious is involved. I feel safer with condoms.

[WilliamErickson]

I don't believe that Truvada can be used as a stand alone for keeping yourself negative. However the studies that I have read say that in the patients that received Truvada vs the patients that received a placebo there was a 94% lower incident for infection, for patients that took the truvada at least 3 times a week. It was higher 99% effective in patients that took it everyday. Now in this study it doesn't say how big the groups were nor what their sexual behaviors were, but I would assume that in order for the test to work there would have to be some unprotected sex happening. Otherwise the result would be inconclusive because of too many variables. However, I for one see 99% protection as a step in the right direction. I have been taking Truvada for about 3 months now, and have had no side effects, I am still negative, but I also still practice safe sex with a condom. I cannot understand why someone wouldn't want to protect themselves in every way that is available.

[Frankly Rich]

The federal government today did an about face and now recommend that men or women at risk for HIV take Truvada on a daily basis. The NY Times reports: "It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year, and most insurers already cover it." This must have the manufacturer of Truvada thrilled. I wonder how the trading in their stock went these past few days. If nothing else, barebacking stocks skyrocketed!

 

Here's the story: http://www.nytimes.com/2014/05/15/health/advocating-pill-us-signals-shift-to-prevent-aids.html?hp&_r=0

[rickp]

I spoke to my doctor about this at my last visit, and she said that she did not recommend it for me specifically. She said as long as you're using condoms, there's no reason to take medication in addition to that. It's an effective enough prevention method.

[+ Gar1eth]

The article says PReP is 99% effective in reducing HIV infection. I wonder what the fail rate for condoms is. I think even if the condom doesn't tear/have a hole, there is still a small risk of catching HIV.

 

I also wonder about the development of resistance to Truvada on it's own and by people who only take it intermittently, become infected, don't know it, and start re-taking the Truvada. Truvada by itself isn't enough for treatment.

 

I think I read somewhere about a trial of monthly intramuscular injections of Truvada or another anti-HIV regimen. I wonder if that's a better way to go. It seems that would be especially good for the porn industry. A certificate of some kind could be given for the injection. No one would be allowed to work without testing or a monthly anti-HIV injection certificate.

 

Gman

[Newly]

In some way gay men are their own worse enemy. Reminds me of right wing Christians who look down their nose at anyone who has a glass of wine and feel righteous because they never touch a drop....and secretly hate the thought that anyone else could be enjoying something that is forbidden to them. The use of condoms is way down, the rate of HIV infection has not gone down in years and now there is a lot of hope that we may be able to change the way we've had to live since the 80's. Whether one uses condoms or not is a risk assessment everyone has to make for themselves, but I guarantee you that even if this is shown to be 100% effective there will be lots of gay men shouting about how they'll NEVER accept the fact that it's possible to have safe sex without condoms....you know, "when I was a child we walked ten miles in the snow to school".

[Steven_Draker]

I spoke to my doctor about this at my last visit, and she said that she did not recommend it for me specifically. She said as long as you're using condoms, there's no reason to take medication in addition to that. It's an effective enough prevention method.

 

I have to agree with Rick: if one consistently uses condoms, it's an effective enough prevention method (not only against HIV, but other STDs too).

 

However studies show that gay men forego condoms up to half the time.

 

 

"... the longstanding admonition to “use a condom every time,” an approach pioneered in the ’80s and ’90s with posters and ads making condoms look sexy and fun, does not seem to be working. True, condoms are highly effective at protecting against HIV, as well as other STDs, including syphilis, herpes, and gonorrhea. They also sometimes break.

 

Moreover, studies since the 1980s have consistently shown that gay men forego condoms up to half the time, depending on the situation, for reasons ranging from “the heat of the moment” to alcohol and drug use to a plain old dislike of how condoms feel.

 

According to Pickett, this means that condom-only prevention campaigns will never succeed in bringing HIV rates close to zero. “If condoms were so wonderful and a part of human nature, we wouldn’t have a problem with rising infections,” he says.

 

And yet, PrEP doesn’t seem to be catching on yet. Part of that is simply PR — not enough people even know what it is. Miller says that Gilead prefers to support LGBT health centers in getting the word out over doing direct advertising. Why would they not go full throttle to boost sales of PrEP? “They know it would be a potential PR disaster,” says Pickett.

 

And indeed, public reaction to PrEP has been mixed, with many concerned that widespread PrEP use will lead to an explosion of unprotected sex in gay men ..."

 

more: http://www.out.com/news-opinion/2013/09/09/hiv-prevention-new-condom-truvada-pill-prep?page=full

 

HIV Prevention, an Overview

 

http://www.rogertatoud.com/wp-content/uploads/2009/07/HIV-Prevention2.png