Prevention of HIV

One other very cool thing here is that this new treatment represents a whole new family of drugs (very sophisticated at that, per Derek Lowe&#x27;s assessment). I thought back in the late 2010s with integrase inhibitors (e.g. dolutegravir), there was a real chance they could achieve the 90-95% reduction targets in new cases, and hopefully this new drug makes that even more feasible.<p>There&#x27;s always the risk of losing previously effective drugs due to resistance, so the value of redundancy cannot be overstated

I wonder how much this will cost? A drug you take 2 times a year could be much cheaper than one you take 365 times a year, and that&#x27;s a big deal.<p>The existing daily pill is really expensive. Australia knew that PrEP would practically eliminate HIV transmission. Even so, the decision to pay for it took years and was fiercely contested. That was before COVID, and people are more willing to pay for public health today. But cheap PReP would make a big difference in the poor countries where HIV prevention really matters.

Please forgive my lack of understanding. This appears to be a great achievement. Is there any risk that a Lenacapavir resistant strain would rise up in many years as a result of treating a large portion of the global at risk population (estimated to be 60m people receiving the injection to materially lower global HIV rates)?<p>Sort of like how antibiotic resistant bacteria rates seems to evolve out of the use of antibiotics? Or is that not a thing and Im just clueless?

It&#x27;s a wonderful (if rare) event when a medical trial is stopped for efficacy.

Without mention of the number of study participants or risk, I was a bit suspicious, but it&#x27;s not a tiny sample size, and not a low-risk group. From the paper:<p>&gt; Among 5338 participants who were initially HIV-negative, 55 incident HIV infections were observed: 0 infections among 2134 participants in the lenacapavir group<p>The infections in the control groups were in people taking other preventative medication, not nothing.

In terms of protecting oneself, what are the actual steps? (E.g. if you&#x27;re HIV- but are participating in activities either directly with someone who is HIV+ or whose partner is HIV+.)<p>Do you schedule a doctor appointment and ask for something specific? And is there anything else to do, such as something over-the-counter?<p>There&#x27;s a dizzying array of terms to learn in this space. PrEP is apparently different from PEP, which I think is also unrelated to what this article is talking about. It&#x27;d be nice if someone put together a 2024 guide for what the latest preventative &#x2F; protection mechanisms are.

&gt; The medication interrupts viral replication by preventing HIV from reaching the nucleus of an infected cell.<p>How does it actually do it?

Derek Lowe is a great writer. Worth reading his &quot;Things I Won&#x27;t Work With&quot; articles if you want to read more of his writing.<p><a href="https:&#x2F;&#x2F;www.science.org&#x2F;content&#x2F;blog-post&#x2F;things-i-won-t-work-dioxygen-difluoride" rel="nofollow">https:&#x2F;&#x2F;www.science.org&#x2F;content&#x2F;blog-post&#x2F;things-i-won-t-wor...</a>

30 years ago in South Africa there was fear about contracting HIV (and so inevitably dying) through the ear via public telephones (which is ridiculous and impossible). Doctors in trauma wards were terrified of contracting the disease. Huge amounts of stigma and misinformation, and little hope.<p>It’s amazing that since then: - A treated HIV diagnosis no longer necessarily changes your life expectancy. - Your HIV negative partner or unborn child will not necessarily contract the disease, if treated. - Treatment adherence requires just two visits a year. - Doctors have a ready solution in the case of accidental potential transmission. - I can’t remember the last time I saw a public telephone.

Relevant from 2022: <a href="https:&#x2F;&#x2F;www.tht.org.uk&#x2F;news&#x2F;heterosexual-hiv-diagnoses-overtake-those-gay-men-first-time-decade" rel="nofollow">https:&#x2F;&#x2F;www.tht.org.uk&#x2F;news&#x2F;heterosexual-hiv-diagnoses-overt...</a><p>I was mind-blown when I learned we were at a point where we could realistically talk about eradicating HIV. Am not a Tory by any stretch of the imagination but props where it&#x27;s due to them for saying it out loud: no new HIV infections in UK by 2030. As far as I understand the current government are committed to this plan also.<p>Of course, no new infections in UK != eradication, which is the next step. I had not heard of Lenacapavir - this is amazing news from Munich.

With regards to HIV and Aids, Nobel price winner Kary Mullis (inventor of PCR test), made many interesting remarks. I thought that was an interesting interview.<p><a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=W1FXbxDrDrY" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=W1FXbxDrDrY</a><p>It&#x27;s a quite old interview (1996), wonder in what ways knowledge has changed regarding the disease.

As with all drugs, efficacy is only one part of the equation.<p>What&#x27;s the potential side effects, both short term and long term, of this treatment?<p>For this treatment, it may be negligible, but without saying so we are only hearing one side of the story.

This is an historic achievement with huge benefits, particularly for Africa.<p>AFAIK, Gilead hasn&#x27;t detailed any commitment to making it available to all who need it. There&#x27;s been talk of $4K -$42K yearly price. Gilead just this month is promising regulatory submissions for approvals soon. The drugs sounds quite complicated and hence difficult to manufacture, perhaps making it an enduring franchise.<p>The original post is raising a most interesting question: in a world where preventing infection is possible, what&#x27;s the standard or incentive for a vaccine? It&#x27;s rare to get 100% prevention from a vaccine. The incentive would seem to depend only on cost, and any vaccine developer would know that Gilead can likely lower cost at will, making it impossible to recoup vaccine development costs.

&gt; Among 5338 participants who were initially HIV-negative, 55 incident HIV infections were observed...<p>Wait what? Those 55 got infected during the trial. What was the incentive to get exposed?

Hell yeah..give it to me.. no not really

I hope that vaccines can be made affordable, otherwise, it won&#x27;t solve anything.