Take This Pill, Don't Get HIV

[Croaxleigh]

Not sure if you've heard about it, but there is a vote scheduled tomorrow by the FDA to determine whether a pill called Truvada will be allowed for use by those at risk for HIV infection to help fight the spread of the disease. A few studies on Truvada have had fairly positive results (a 44% reduction in infection rates among gay and bisexual men and a 75% reduction in infection rates among heterosexual couples), and if the FDA approves the new use for the drug it will be the first HIV PrEP (pre-exposure prophylaxis) treatment available for widespread use.

The theory behind PrEP is that if you're taking medicine that is effective against HIV, the virus will be disabled before it has a chance to infect you if you should come in contact with it. It's not much different than current PEP (post-exposure prophylaxis) treatments that are given to individuals who may have come in contact with the virus, except for the fact that it's a preemptive action against infection instead of a response.

From what I've seen, responses to the possible approval of Truvada have been a bit mixed. Some advocates think that it's a major step forward in that it will help protect people in serodiscordant couples (couples that have one HIV+ and one HIV- partner) and various other situations where they could run a risk of becoming infected. Some HIV advocates think that the approval of Truvada as a PrEP treatment would be horrible, however, as they see it as encouragement for people to partake in risky behavior or unsafe sex.

Of course, the point that a lot of the reports on the vote seem to gloss over is that Truvada isn't necessarily the easiest thing in the world to take. It's one pill a day, but you need to take the pill every day at approximately the same time and even a few missed doses could cause problems if you've come in contact with HIV during that time. Side effects when getting used to HIV medications aren't necessarily pleasant, either... if you have a bad reaction to the drug, getting your groove on could very well be the furthest thing from your mind during the first several weeks that you're taking it.

So what do you think? Is the potential availability of Truvada as a PrEP treatment a good thing for AIDS prevention or is it the "typical American easy way out" as Michael Weinstein of the AIDS Healthcare Foundation described it? If you were in a serodiscordant relationship, would you take it (or encourage your partner to take it)? Are there other factors (such as cost) that would sway your decision one way or the other?

[Akranadas]

I think such a pill will create a false sense of security. People won't see the 'Reduces infection rate by 44% or 75%, they'll simply see it as 'anti-aids' pill.

[Rotlung]

I can't see this drug being used on a large scale by most people - taking a drug daily to avoid HIV isn't quite the same as wearing a condom for protection. With the issues of side-effects and development of resistance (not sure if it applies), it seems to be largely a boon only for serodiscordant couples. Even then, for how long can/should the HIV- partner take it?

[Fish Of Doom]

what akranadas said has merit. then again i have a low opinion of humankind and its collective thinking abilities.

more on topic: i think this is an absolutely fucking fantastic development, science-wise. now they just need to improve it as much as possible. it could be either thing, but is overall a good one, IMO, at least without factoring in potential human idiocy. if in a serodiscordant relationship, i'd ask what my partner wanted instead of going by my own wishes. as for other factors: safety, safety and more safety.

on a related note: what the fuck is an HIV advocate???

[Vintage]

what the fuck is an HIV advocate???

This made me laugh so hard.

If I was in a serodiscordant relationship I would take the pill if I was not HIV positive, and if I was HIV positive I would encourage my partner to take the pill. I see no reason to not protect ourselves as much as possible (and as much as we are comfortable with protecting ourselves) from an incurable disease that I could potentially spread to the person or be infected by the person I'm in a relationship with.

I think such a pill will create a false sense of security. People won't see the 'Reduces infection rate by 44% or 75%, they'll simply see it as 'anti-aids' pill.

The same can be said about condoms or birth control pills really. There is no such thing as 100% protection and some people think if they use protection method X they are immune to everything. I don't think the pill should be banned because some people are complete idiots.

[Croaxleigh]

Even then, for how long can/should the HIV- partner take it?

Once per day, every day, for the duration of the relationship/their life/until a cure is found. Just like if they were taking the pill because they were HIV positive. I guess the negative partner could stop if they decided to just not have sex anymore, but eh. (Of course they could stop taking the pill and go back to condom use only at any time.)

As far as resistance goes, that is a factor but not in the way that you might think. The individual taking the pill will likely experience some resistance, but that's not necessarily a bad thing... developing resistance to HIV medications results in a lessening of side effects and a reduction of the "oh dear God I think I'm dying" feeling that some HIV meds can give. Where resistance becomes a factor is that HIV can become resistant to the drug if you end up with uneven levels of the drug in your bloodstream as a result of missed doses or taking doses at random times. During periods where the amount of the medicine is low, the virus can adapt and mutate to bypass the mechanism by which the medicine kills the virus or stops it from replicating. Since the use in question is a PrEP treatment, having a low amount of the medicine in your body at the time that HIV enters your system means that some of the viral cells could mutate so that they're not affected by the medicine and end up infecting you anyway. The worst part of that is that when HIV becomes immune to an antiretroviral medication it generally becomes immune to the entire class of drugs that the medication belongs to. There are five (I think) classes of ARVs... infection due to not taking PrEP treatments properly could knock one of those five off the board before you even get diagnosed. And in the worst-case scenario you could reinfect your partner with the mutated version of the virus so that the class gets knocked off the board for them as well.

I don't think that the medicine is really intended for the general public, per se; it's not for people who just want to go out and get their freak on without worrying about HIV infection (and honestly, the potential side effects likely wouldn't be worth it if it was.) Most of what I've read about it indicates that it's only going to be prescribed to people who have a legitimate need for it because they are in a serodiscordant relationship or are otherwise at greater risk of HIV exposure than the general public.

[Alliance]

I think most people won't have a day to day need for this kind of pill. If some one is in a situation where such a pill is needed than perhaps having it as a heavily regulated prescription pill such as doctors give to women today might be a good solution.

[Paladin]

What idiots will assume is not relevant. If anything it just weeds out stupid genes.

[Dimension]

I really don't see any strong arguments against this.

It is protection. If protection encourages unsafe behaviour, then so be it, this does not mean that the protection should be limited. We have all kinds of protection in literally every part of our lives, from condoms to airbags to fire insurance. All of those things ultimately may well cause unsafe behaviour in certain individuals, but I cannot see how this justifies banning the protection or restricting it beyond reason.

[TheWickedGerman]

I agree with Dimension. With that logic, we should ban safety belts and airbags, it fives a false sense of security and leads to risky driving

It´s additional protection, so I´m for it. If some people mistake it for an "AIDS immunity pill", well Evolution will take care of them sooner or later.

[Akranadas]

The problem is that Aids isn't a 'natural selection' type of infection, as it can remain somewhat undetected in a host while they can go infecting other people, that isn't natural selection working.

[Croaxleigh]

Exactly. It can take up to six months (or in some cases, up to a year or more) before HIV shows up on tests. And that's assuming that people try to get tested after they have contact with someone that has HIV (whether the infected person knows it or not.) Some people don't even get tested when the first signs of infection show, just because they don't know what the first symptoms that present with HIV infection actually are.

Also, to update this thread, the FDA panel has backed the approval of Truvada as a PrEP treatment option for people at high risk of becoming infected. It will now be put to a vote by the FDA as a whole, who may or may not follow the panel's recommendation; the vote is expected to happen by the middle of June.

[Paladin]

The problem is that Aids isn't a 'natural selection' type of infection, as it can remain somewhat undetected in a host while they can go infecting other people, that isn't natural selection working.

Still natural selection. The people who chose to have unprotected sex with this individual without getting an HIV test first are not too bright either.

[TheWickedGerman]

My comment was to address the "it will lead people to risky behaviour as they might think it´s an "immunity pill" argument. If people are so "stupid" that they will start a risky sexual behaviour, because off a pill that only reduce the risk but not eliminate it, they are more likely to feel the fatal consequences of an HIV infection. So their "stupidity" get them killed, therefore "natural selection"

[Akranadas]

Still natural selection. The people who chose to have unprotected sex with this individual without getting an HIV test first are not too bright either.

That is probably the most horrible thing you've ever said.

As pointed out, it can take 6 months to a year for signs of HIV to show, during that time you wouldn't know that you have the infection unless you got yourself tested. You don't need to have unprotected sex with someone with HIV to contract the infection, any contact with most bodily fluids will do the trick, even helping that guy who fell down the stairs and cut open his leg could potentially leg to HIV infection if he was infected; how is that Natural Selection at work? So what you're saying really is people who have unprotected sex should be taken out of the gene pool by taking a risk based on the information the other party gives them? Are you going to make a potential sexual partner have a HIV/AIDS test before engaging in unprotected sex if they tell you they do not have the infection?

The drug, as far as I can tell will benefit those working around HIV aids rather than those seeking to have sex with infected individuals, so we're looking at this drug being a massive benefit for Doctors, Nurses, Paramedics, social workers and probably more in high risk fields.

[Makemap]

The Pill would end up costing a lot of money. As many people may abuse it for sex.

[Starfisher]

Why would lots of use make it cost more? You can mass produce most drugs for essentially nothing. The cost of a drug is almost entirely profit-taking from the original developer. You can expect ridiculously high initial costs which will eventually drop with higher volume, until it finally becomes generic.

For first release, they probably won't even make it widely available, since OHMYGAWD PEOPLE HAVE SEX?!?! still hasn't really percolated through the government yet. Probably first responders or people in relationships with a partner who has diagnosed HIV/AIDS. I doubt they will simply allow you to get it over the counter, at least not at first.

edit: Also, basic research allowed me to discover that it has some nasty potential side effects, so I doubt you can just pop this for your whole life without serious consequences.

[Paladin]

So what you're saying really is people who have unprotected sex should be taken out of the gene pool by taking a risk based on the information the other party gives them? Are you going to make a potential sexual partner have a HIV/AIDS test before engaging in unprotected sex if they tell you they do not have the infection?

Yes, absolutely. In this day and age, if you have unprotected sex, ever, with anyone, without going down to the nearest clinic doing free HIV testing and getting a clear bill of health for both of you, you are a moron. A complete, and utter idiot.

It doesn't matter whether someone tells you they're a virgin, that they're not at risk, whatever. You use protection. Always, every time, no exceptions. If you're thinking about going without, because you've been in a monogamous relationship for a significant period of time, then you both get tested. Period. No exceptions, not a single one.

[Croaxleigh]

Unless you're booking your sexual escapades a year in advance, going with someone to the free clinic for a test won't necessarily tell you anything. In most cases it's unlikely that a positive test will result if the individual has been infected for only a few months. It's often recommended that people have at least two tests after they believe that they have come in contact with HIV, six months apart. It's not unheard of for it to take up to two years for a positive result to happen, though it's not exactly likely.

Makemap: The pill is already in production and has been for a few years. If it's approved, it's unlikely that doctors would even prescribe it for people intending to have casual sex. The approval will be specifically to protect people at high risk. Given the high cost of HIV medications in general, the strict adherence requirements and the side effects, it's really not something that will be prone to abuse. People who want to use it for casual sex would likely drop it in a few days because they didn't think it was worth it.

[Paladin]

Unless you're booking your sexual escapades a year in advance, going with someone to the free clinic for a test won't necessarily tell you anything. In most cases it's unlikely that a positive test will result if the individual has been infected for only a few months. It's often recommended that people have at least two tests after they believe that they have come in contact with HIV, six months apart. It's not unheard of for it to take up to two years for a positive result to happen, though it's not exactly likely.

Hence the part where I mentioned "you've been in a monogamous relationship for a significant period of time". You shouldn't even be considering going bareback with someone you haven't been with long enough to get a sort of reliable HIV test result on. Honestly I kind of thought this was common knowledge stuff...

[Starfisher]

You're on a nerd gamer board. Where pretty much everyone isn't a gay man. Make a venn diagram and do the math on that one :P

Last I remember looking, gay men account for about 2/3rds of the new HIV infections every year, which probably makes the culture of checking up on such things a lot more strict than it is in hetero land.

[Croaxleigh]

Actually, the fastest-growing segment of new infections comes from married women. As of 2010, half of the documented cases of HIV infection in the United States were female, and the director of UNAIDS (the United Nations AIDS prevention coalition) has even referred to the AIDS epidemic as "an epidemic of women."

[Starfisher]

Are you sure you're talking about the US only? 23k new male-male caused cases alone in 2009 versus 10k new infections in women total. I'm sure outside the US it might be different. Also, "fastest growing" doesn't necessarily mean "most infections" - it just means highest growth rate. 1 growing to 2 is "faster" than 1000 going to 1500.

Anyway, my point was more that the gay male community is going to be way more aware of HIV/AIDS risks than anyone else, because they are far and away the most afflicted population. If we go with 10% of the male population being gay, that would mean that 10% of the population is accounting for significantly more infections than the other 90%, which one would expect to have a cultural impact, an impact you would expect to be much more muted in the other population.

[Paladin]

Whatever. It doesn't matter whether you're hetero or homosexual, the safe behaviors are the same. And having unprotected sex with anyone you haven't been in a monogamous relationship with for a year or two and getting a test done is stupid, I don't care what your orientation is.

[Croaxleigh]

On a related note, the FDA apparently voted today to allow OraQuick HIV tests to be sold commercially; the test received initial approval, with a full vote coming later in the year. If you've never taken an OraQuick test, it's basically a mouth swab that you rub on your gums and put into a developing solution for 20 minutes. They're considered to be around 93-95% accurate, and if you get a positive result it's recommended that you get it confirmed with an ELISA or Western Blot blood test. These are the same tests that a lot of AIDS service organizations and public health departments use for their testing these days because they deliver quick results without the need for blood.

It wouldn't be the first take-home HIV test, but it would be the first one that you can develop and read yourself. Current OTC tests require you to send them in for confirmation.

[Croaxleigh]

Just wanted to post an update to this topic; the FDA approved Truvada for use by HIV-negative individuals. Before an individual can get the drug they have to take an HIV test and then be tested again every 3 months to ensure that they are and remain negative. Doctors should stress the use of the drug in combination with condoms, how important it is to take the drug on time and every day, and the potential side effects of the drug. I think I read somewhere that people taking the drug may have access to counseling services as well, though I haven't been able to find that link again and it hasn't been mentioned in some of the other news stories I've read.

[Agdune]

Cool, Harm minimisation at work. Barring a total vaccine and concentrated world-wide targeted effort (like Smallpox) HIV's never going to completely go away, objecting to truvada on the basis that this might not be a perfect solution is pure unrealistic idealism. Having access to methods at reducing its prevalence can only be a good thing, even if some people don't bother to learn about it and use it as an excuse to not care about the risks. Like Dim and TWG said; it's like seatbelts. That some people misuse them doesn't mean they're a bad thing.

Also, Paladin's correct. If you're sexually active, use protection, regardless of what demographic you belong to. Statistics don't protect the individual. Assuming someone's clean is the best way ever to contract some form of STI/STD, unless you know exactly what that person's been doing for the last few years. Fuck, I've done it, and it was incredibly stupid; I was lucky and only got a bad rash that took about 4 months to clear up (with treatment) but it could just have easily been something more serious; my initial impressions of the girl were quite incorrect, she appeared to be quite sensible and cautious, but had actually had unprotected sex with around about 30 guys, including myself. Thinking 'oh boy I wish I'd done what every sexual health lesson ever taught me and used protection' wouldn't exactly have made much retroactive difference if I'd picked up genital herpes or Hepatitis.