A New HIV Prevention Strategy Sparks Excitement - and Protests Over Cost (npr.org) 47
"Lenacapavir is not a new drug," reports NPR. "It's been approved by the FDA in the United States for multi-drug resistant HIV treatment since 2022."
But instead of treating HIV, what if it were used for preventing infections? The treatment consists of a twice-yearly injection... Early trial results were released in June and generated great excitement, indicating 100% efficacy. On Wednesday, July 24, the full peer-reviewed results were released at the AIDS 2024 conference, confirming the preliminary data... This treatment offers an alternative to the current standard of core for HIV prevention efforts for over a decade: taking a pill like Truvada every day...
Any eventual approval and widespread use would come with challenges... Lenacapavir's cost as HIV treatment in the United States in 2023 was $42,250 per new patient per year. Oral PrEP options, on the other hand, can cost less than $4 a month. "The biggest gap in prevention isn't medication, it's accessing medications," says Dr. Philip Grant, clinical associate professor and director of the HIV clinic at Stanford University School of Medicine.
Activists across Uganda and South Africa have urged Gilead Sciences to license lenacapavir to the Medicines Patent Pool — a United Nations-backed organization that partners with governments, industry and other organizations to license medications. This would allow for manufacturing of generic versions of the drug at a fraction of the cost... [A] group of Médecins Sans Frontières activists gathered at AIDS 2024 and called for an "immediate global action to break Gilead's monopoly on lenacapavir."
In a statement Gilead said they couldn't set a price because the drug had not yet been approved — but that Gilead "is committed to access pricing for high-incidence, resource-limited countries." Gilead will ensure dedicated supply of lenacapavir for HIV prevention in the countries where the need is greatest until voluntary licensing partners are able to supply high-quality, low-cost versions of lenacapavir.â
Gilead is developing a robust direct voluntary licensing program to expedite access to those versions of lenacapavir in high-incidence, resource-limited countries. We are moving with urgency to negotiate these contracts.
But instead of treating HIV, what if it were used for preventing infections? The treatment consists of a twice-yearly injection... Early trial results were released in June and generated great excitement, indicating 100% efficacy. On Wednesday, July 24, the full peer-reviewed results were released at the AIDS 2024 conference, confirming the preliminary data... This treatment offers an alternative to the current standard of core for HIV prevention efforts for over a decade: taking a pill like Truvada every day...
Any eventual approval and widespread use would come with challenges... Lenacapavir's cost as HIV treatment in the United States in 2023 was $42,250 per new patient per year. Oral PrEP options, on the other hand, can cost less than $4 a month. "The biggest gap in prevention isn't medication, it's accessing medications," says Dr. Philip Grant, clinical associate professor and director of the HIV clinic at Stanford University School of Medicine.
Activists across Uganda and South Africa have urged Gilead Sciences to license lenacapavir to the Medicines Patent Pool — a United Nations-backed organization that partners with governments, industry and other organizations to license medications. This would allow for manufacturing of generic versions of the drug at a fraction of the cost... [A] group of Médecins Sans Frontières activists gathered at AIDS 2024 and called for an "immediate global action to break Gilead's monopoly on lenacapavir."
In a statement Gilead said they couldn't set a price because the drug had not yet been approved — but that Gilead "is committed to access pricing for high-incidence, resource-limited countries." Gilead will ensure dedicated supply of lenacapavir for HIV prevention in the countries where the need is greatest until voluntary licensing partners are able to supply high-quality, low-cost versions of lenacapavir.â
Gilead is developing a robust direct voluntary licensing program to expedite access to those versions of lenacapavir in high-incidence, resource-limited countries. We are moving with urgency to negotiate these contracts.
That's a lot more expensive (Score:5, Insightful)
The strategy I use costs me nothing and is very effective, but I guess it's not for everyone.
Re: That's a lot more expensive (Score:2, Insightful)
Re: That's a lot more expensive (Score:2)
One wonders if Slashdot are ever going to fix how's Unicode non-ascii characters are handled. They are always displaying as a bunch of non-coherent nonsensical characters.
Only Slashdot. Every other site is fine...
Anyway, I digress...
Re: That's a lot more expensive (Score:5, Informative)
Ever heard of rape, blood transfusion, infidelity?
Re: That's a lot more expensive (Score:5, Insightful)
Oh no that only happens to other people. You know “those” people.
Re: That's a lot more expensive (Score:4, Insightful)
Re: (Score:2)
Your plan is to tell people not to have sex? Let me know how that works out.
Re: (Score:2)
It's mostly transmitted by anal. Straight people in monogamous relationships have very little exposure to this. Yes, "little" is not literally zero, there are other risks, like the blood supply, getting raped, etc. but they're not large vectors compared to anal and needle sharing by drug users. Anal has always been seriously unhealthy, even the ancient Romans knew it, which is part of why they thought being a bottom was "unmanly" because the risk there was obvious even way back then. Given sexual practices, it will remain unhealthy for the foreseeable future.
Given that sexuality is imprinted, the people who avoid harmful sexual memes will end up healthier and more successful in the long run now that birth control has tamed the reproductive advantage that being a massive horndog used to give. It seems that those folks are now imprinting young on non-reproductive sexuality thanks to internet porn and identifying as any number of non-straight types. Though I admit that it's weird to watch people worried about g-nocide to be deliberately sterilizing themselves.
What would you say to people living outside of the United States, like the UK, where most new HIV diagnoses are the result of heterosexual intercourse? Also, there's a lot of words in that salad, but deliberately sterilizing themselves????
Re: (Score:2)
Ever heard of being hit by a meteorite?
Re: (Score:3)
We did say that, once the majority stopped ignoring AIDS as a 'gay disease' and started worrying about random exposure.
The people who needed to listen refused to; "Use a condom for hookups" was apparently too much to ask.
Re: (Score:2)
The strategy I use costs me nothing and is very effective, but I guess it's not for everyone.
Is this the same strategy people use when they complain how horrible Amazon is to their workers?
Re:That's a lot more expensive (Score:4, Insightful)
Honestly... for sexually-transmitted AIDS... "Don't have sex without a condom unless you're in a committed relationship with a partner you trust". That will drop your odds of infection through the floor. I've no sympathy for anyone going in raw in a casual encounter. Is it as nice? No. Deal with it.
For the rest? The blood supply is adequately protected, and if you don't do drugs with shared needles or French kiss someone with bleeding gums while having questionable personal oral hygiene yourself, you're not going to get AIDS from anything non-sexual either.
It's still possible to have a cheating partner infect you, but c'mon. Realistically, if you get AIDS today you're choosing to get AIDS. It's not the 1980s any longer.
Re: That's a lot more expensive (Score:3)
PrEP is 100% effective.
So it's actually more effective than a condom. Which seems counterintuitive, but true.
Although PrEP will only protect you from HIV, so best to use a condom too to protect you from all the rest.
(Doxy-PrEP helps for some of the rest too)
Re: (Score:1)
Re: That's a lot more expensive (Score:1)
Sure you can get syphilis from just kissing someone, so I guess that guy just goes around in a hazmat suit all day.
Best to just ignore him and people liked him, and leave them to their own little world.
Re: (Score:3)
I don't count it as a "mistake" when you knowingly go against ubiquitous expert advice. I didn't cry over anti-vaxxers and COVID denialists who wheezed to death in ventilators, either.
Play stupid games, win stupid prizes. We have over 8 billion people on the planet, we can afford to lose some idiots with high maintenance costs for society.
Re: (Score:2)
That's all fine if you have access to condoms and can afford them, and you aren't a sex worker who has to forego them to make a moving. Also a bit of a bummer if your partner has it and you want kids.
As a public health issue, simply berating people isn't a very successful strategy either.
Re: (Score:2)
I don't expect people to give up sexual activity out of fear of death, it's too fundamental to human experience - but the people I'm talking about are in developed Western nations. It's not that difficult to get condoms.
And if you're a sex worker who doesn't enforce a mandatory condom policy, no sympathy. I'm not opposed to sex work, but you have to take reasonable public health precautions. If you can't make a living that way, you need to find other employment. I refuse to accept that you have a right
Re: (Score:2)
It's actually no big deal for people with AIDS to have children now. We have medications that prevent the other partner and the child getting it.
The real issue here is that there is a very effective and potentially cheap medication. Patent law is supposed to encourage continued innovation, not charging 1000x the nominal cost of something that could make a huge difference to a lot of people.
There has to be a better way.
Re: That's a lot more expensive (Score:4, Informative)
Baron, you have a lot to learn about HIV, its prevention, its treatment, and its lifecycle. Your mind is stuck in the 1980s.
Many advanced have been made in treatment and prevention.
HIV medication is such that those who have HIV and take the medication daily cannot pass on HIV (known as U=U).
PrEP is 100% effective at preventing those taking it from getting HIV.
PEP is effective, within 72 hours, of preventing someone who has been exposed from being infected.
You need to jump forward a few decades, fella.
Re: That's a lot more expensive (Score:3)
> Also a bit of a bummer if your partner has it and you want kids.
U=U : Undetectable = Untransmittable
If your partner is taking HIV medication correctly and thus is undetectable, then they cannot transfer the virus. Hence you are safe.
Re: (Score:2)
That's what I meant. With the right medication it is safe to have children, and that's a good thing. It affects people who were safe but are partners of people who make mistakes or got infected through blood transfusions etc.
Blame is not the right response here, asking why they are charging 1000x what it costs is.
Re: That's a lot more expensive (Score:3)
It's HIV, not AIDS.
Contracting HIV can lead to AIDS.
"Human immunodeficiency virus (HIV) is an infection that attacks the bodyâ(TM)s immune system. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of the disease."
Most people with HIV, who get proper treatment, don't get AIDS.
https://www.mayoclinic.org/dis... [mayoclinic.org]
Re: (Score:3)
This only works if your partner is 100% honest.
exactly (Score:1, Interesting)
Re: (Score:2)
So the proposal is that society spend $40k a year per homo who wants to bareback? Because it's less hassle for the homo than the pill that's $50 a year? And oh yeah all this barebacking has created and spread a bunch of other STDs do like antibiotic-resistant gonorrhea.
It would be amazing if you had read anything about the study involved - which was performed on sex workers in South Africa, not "barebacking homos." The barebacking crowd all went on PrEP years ago, which is why HIV infections as a result of heterosexual intercourse are now a much higher percentage of new infections, and even the majority of new infections in many places, notably the UK.
Re: (Score:2)
That's a lot like expecting murder to stop if we made murder illegal someday. Hey wait a second ....
Re: (Score:2)
Cash grab (Score:1)
If these antivirals work anything like antibiotics, it's something you should take for an acute infection, not continually throughout the year.
Sounds like $4/mo for PReP wasn't bringing in enough, so they wanted to have a "luxury" option available for those who can pay more.
I'm also suspicious about calls for "access" to these medications, if that means paying the manufacturer whatever outrageous price they're suggesting.
Re:Cash grab (Score:5, Interesting)
They do not work like antibiotics, and you need to take them continually for them to work. This is because HIV integrates into the genome, so once you're infected it's too late. HIV's polymerase is very error prone, so these drugs are fake C's that can't be attach to anything after they're used. The result is that the HIV is inactivated before it can complete the infection. HIV cannot develop a resistance to this if taken consistently and regularly. The issue is if people stop taking it, get infected, and then resume taking it. That can lead to resistance.
Truvada used to be expensive, but was required to be covered as preventative care. Then the patent expired a few years ago, and it became very cheap (and also available in more countries). However, Truvada doesn't have high bioavailability, which means you need to take large pills and it can put stress on your kidneys filtering it out.
The same company came out with a new one, Descovy, that is basically a more bioavailable version. Tiny pills, less kidney stress, but of course still covered by the patent so expensive. I haven't seen it outside of the US for that reason, and in the US some insurers won't cover it unless you get a priori authorization for why Truvada won't work for you (kidney issues would be one such reason). Other US insurers cover it fully (or enough that the manufacturer's copay card covers the balance).
The current injectable version is every 2 or 3 months, and is designed for people who have compliance issues taking a pill daily. Or are in unstable housing situations, etc. You really don't want people to get infected and then take PrEP drugs, because it can cause resistance. HIV treatment includes additional drugs, not just these.
Re: (Score:2)
Hey, why didn't you invent something better? If you're mad they made this available at $50k per year .. how much did you make your cure available at?
Re: As a bisexual pervert I have to say (Score:3)
You realise that a lot of STDs are still passed via "oral pleasures"...!
"current standard of core" (Score:2)
Editors? Hello?
What is the ultimate value of this approach? (Score:2)
How much are you willing to pay?
(don't kill the messenger)
Correction: (Score:2)
It will be cheap in Germany (Score:2)
And the local legal bordellos will be happy to pay the price.
West Wing got it right (Score:1)
Toby -
The pills cost 'em four cents a unit to make.
Josh -
You know that's not true. The second pill
cost 'em four cents to make. The first
pill cost 'em four-hundred million
dollars.
Most drug R&D is shouldered by the US. Other countries say to drug makers we'll pay you X or steal your patent. This means the US consumer/insurance is charged more
Wrong comparison (Score:3)
The relevant comparison is the cost of condoms. I have no idea what they cost in Uganda and SA but ChatGPT has an answer:
In Uganda, a 10-pack of affordable condoms typically costs between 5,000 and 10,000 Ugandan Shillings (UGX). This is roughly equivalent to $1.30 to $2.60 USD.
In South Africa, the price for a similar 10-pack usually ranges from 20 to 50 South African Rand (ZAR), which is about $1.30 to $3.20 USD.
Why should Gilead sell their medicine at a price point that is lower than the market rate when Africans can stop being stupid and buy condoms?