U.S. Recommends Daily Pill to Fight AIDS Infections

[Joe K]

New York Times Article

(first few paragraphs)

Federal health officials recommended Wednesday that hundreds of thousands of Americans at risk for AIDS take a daily pill that has been shown to prevent infection with the virus that causes it.

If broadly followed, the advice could transform AIDS prevention in the United States — from reliance on condoms, which are effective but unpopular with many men, to a regimen that relies on an antiretroviral drug.

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.

The guidelines tell doctors to consider the drug regimen, called PrEP, for pre-exposure prophylaxis, for gay men who have sex without condoms; heterosexuals with high-risk partners such as drug injectors or bisexuals; patients who regularly have sex with anyone they know is infected; and anyone who shares needles or injects drugs.

Officials at the Centers for Disease Control and Prevention have long been frustrated that the number of H.I.V. infections in the United States has barely changed in a decade, stubbornly holding at 50,000 a year, despite 30 years of official advice to rely on condoms to block transmission.

http://www.nytimes.com/2014/05/15/health/us-recommends-daily-pill-to-fight-aids-infections.html?hp

Joe

[mecch]

cool.
but one hick - only 10K on truvada??? this seems low.  I guess they didn't count all the combo pills. 

[Joe K]

cool.
but one hick - only 10K on truvada??? this seems low.  I guess they didn't count all the combo pills. 

The article says $13k annually for the Truvada.  There are no other "combo" pills involved.   

Joe

[mecch]

10,000 Truvada prescriptions....   Yes, but that is not how many HIV+ people in USA take Tenofovir + Emtricitabine as part of their combo.....   Just pointing that out....

[drewm]

10,000 Truvada prescriptions....   Yes, but that is not how many HIV+ people in USA take Tenofovir + Emtricitabine as part of their combo.....   Just pointing that out....

Meech this is not for HIV+ peeps, it is referring to using Truvada as a prophylactic.

[tednlou2]

Since a cure and a vaccine seem so elusive, perhaps this will be "the cure" of the next generation.  I was shocked by the stats I didn't know before-- 99% effective if taken daily and 90% effective even with missed doses each week.  That is huge.  As I said before, parents should discuss this with their kids, like they do birth control-- especially a gay son, but also straight kids.  I know there will be those (even cool with being gay) who will think it promotes sex to your kids.

I thought I read somewhere that the average age of infection is like 25.  Could be remembering that wrong.  Anyway, kids can now stay on parents insurance until 26, so that would help pay.  I would assume insurance would have to start paying, since it is now recommended by the Health officials.  But, I know many insurance companies require patients to pay a huge co-payment.  And, then you're paying all or most of the cost during the time you're paying your deductible.  So, the government needs to make sure people have access and not just those better off.

[Joe K]

I thought I read somewhere that the average age of infection is like 25.  Could be remembering that wrong.  Anyway, kids can now stay on parents insurance until 26, so that would help pay.  I would assume insurance would have to start paying, since it is now recommended by the Health officials.  But, I know many insurance companies require patients to pay a huge co-payment.  And, then you're paying all or most of the cost during the time you're paying your deductible.  So, the government needs to make sure people have access and not just those better off.

Too bad they blocked the ability to negotiate drug prices for government programs.  I wonder how they plan to pay for the hundreds of thousands of new Truvada users.

Joe

[tednlou2]

Too bad they blocked the ability to negotiate drug prices for government programs.  I wonder how they plan to pay for the hundreds of thousands of new Truvada users.

Joe

^^^ yes, yes.  I will never understand how repubs explained the rationale for that.  I just remembered they didn't have to, as they held members of their own party hostage to get it passed. 

[mecch]

Meech this is not for HIV+ peeps, it is referring to using Truvada as a prophylactic.

I get it that.
The way I read the NYT article is that there are 10,000 total Truvada prescriptions, so I supposed I misunderstood.  I guess they meant there are 10,000 people now on Truvada as PrEP and the projection is 1/2 a million.

(The article does not specifically say 10,000 people now on Truvada as PrEP.)

[Joe K]

^^^ yes, yes.  I will never understand how repubs explained the rationale for that.  I just remembered they didn't have to, as they held members of their own party hostage to get it passed.

Hopefully, the price tag for the Truvada will get America to rethink Universal Coverage, or at least to negotiate drug prices.  Adding 400,000 new patients, ought to earn us one hell of a discount.

Joe

[tednlou2]

Here's the CDC release with their recommendations.  I didn't think the NY Times article linked to it?? 

http://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf

[buginme2]

This article got me - feeling strangely odd about having HIV - which in turned caused me to get very fucking pissed off. 

1.  I support PreP and agree with the recommendation.

2.  My partner is negative.  It sucks when your disease causes someone else you love to take a medication (not without its side effects and nastyness) to protect them from you.

[vertigo]

Great news!  This is a big day for HIV prevention.

I too am surprised at the number of current Truvada prescriptions.  Paragraph 3 says there are "fewer than 10,000"  (in the US?), while paragraph 25 says that 2,319 are now taking it for PrEP.  Obviously many people take the individual Truvada components in single-tablet regimens, i.e. Atripla, Complera, Stribild.  And of course some take Epzicom instead.  Still, I thought the overall usage would be higher.

Gillead has kept their head down, but they're looking at a huge windfall.  I don't think we've heard the last of the condoms vs PrEP debates if insurers start paying out big dollars for prophylactic treatment.

Still, congrats to the CDC for a bold and forward-thinking endorsement.

[YellowFever]

The price of Truvada should be irrelevant by 2017. But I don't see how the insurance companies would agreee to this. In order to prevent a lifelong infection, they have to pay for everyone else take a lifelong prophylactic medication? Sounds like a wet dream for Gilead. PEP probably makes more sense. Unless, they can make PrEP part of a pre sex routine..like douching and then applying Truvada ass cream...

[mecch]

Do "insurance companies" get to approve or disapprove CDC recommendations? 

[YellowFever]

Dont know, but I doubt the CDC has legal authority to compel insurance companies to provide PrEP, Maybe they could put it as a qualifying requirement under obamacare. I.e. its not a real insurance plan unless prep is included. If the CDC did that, more people would be receiving letters saying that their coverage has been dropped because the plan they were on no longer qualifies...

[mecch]

You live in the states? I don't.
Here in Switzerland the Federal medical board just decides what must be covered, publishes the list each year, and thats that.
I read some Swiss and French news about HIV and it seems the cost of the new Hep C and the cost of PrEP are real challenges to the system.  I don't think either country has announce yet who gets access to the treatment. But I'll make a point of checking and repost.
Anyway its interesting that STI treatment / prevention breakthroughs are pricey and difficult for rich countries to fund...

In Switzerland, 2012, 6313 prescriptions for Truvada total. 
Not including 3313 more for Atripla.
Truvada cost was the 7th highest total outlay, of all drugs, at 58million+ CHF, about 9,200 CHF a person on it, annually... (10,200 USD)
Herceptin was the 5th, and costs 28,600 CHF per person annually. (breast cancer?)
Revlimid is 19th total outlay, and costs almost 50,000 per person annually. (MDS bone marrow cancer?)

if i read the chart correctly

[leatherman]

If the CDC did that, more people would be receiving letters saying that their coverage has been dropped because the plan they were on no longer qualifies...

or insurance companies could just do the right thing in that situation and adjust their plans to be in compliance.

[zach]

maybe this is a touch of paranoia here

i hope i don't see the day when demand outpaces the supply of truvada limited by production. and meds are going to negative and healthy people that can afford them. instead of to positive people that can't afford them or have other access difficulties

[YellowFever]

You live in the states? I don't.

I did. And unfortunately had my unfair share of engagement with the insurance companies. They didn't seem like people keen to do the right thing, as leatherman says. Its more like make the right profit. In that sense, I'm glad to be currently back in a country that practices socialized medicine. Although having said that, here in the UK, the NICE has decided not to approve a new breast cancer drug, Kadcyla due to cost.

So currently it is unclear what the cost for PrEP is, from a community health perspective. Do they need at least 20% of the gay population on it before seeing infections go down? That would be too pricey I suppose...

[buginme2]

Is the United States at the forefront of HIV treatment and Prevention?  After all we recommend that everyone, regardless of CD4 count start meds unlike most other countries that are still holding on to a relic 350 cutoff.  And we now recommend Truvada for HIV negative people at risk. 

Or are we pushing drugs on those who dont need them?

Both?

I really think the recommendations were made with the best intentions.  But it is interesting.  Canada has been at the forefront of Treatment as Prevention (British Columbia in particular) I wonder if they will follow.

[tryingtostay]

I can't remember if I was aware of this or not during the past few years.  Hind sight I say I would of took this if I would of known about it but that's only because my situation now, but if I know myself I would say that if I did know about it I probably dismissed it in order to conserve being out

[mecch]

I can't remember if I was aware of this or not during the past few years.  Hind sight I say I would of took this if I would of known about it but that's only because my situation now, but if I know myself I would say that if I did know about it I probably dismissed it in order to conserve being out

? Don't get the last part.  You would have refused, in order to stay in the closet?  Or, please clarify, if you wish.

[vertigo]

Good followup story from the New York Times:

http://www.nytimes.com/2014/05/16/health/aids-groups-back-anti-hiv-pill-amid-concerns-doctors-and-patients-will-resist.html?hpw&rref=health&_r=0

Dr Paul Sax also sounds a cautionary note:

http://blogs.jwatch.org/hiv-id-observations/index.php/cdc-recommends-broader-use-of-pre-exposure-prophylaxis-can-we-make-it-happen/2014/05/15/

One item of particular interest: it appears the AHF and Mr. Weinstein are pretty well isolated in the anti-PrEP stance.  Basically every other HIV/AIDS organization in the US (68 total) have called him out on it.

[mecch]

Maybe PrEP should be available in male prisons, as well. I dunno, but could image there is some transmission happening there...

[buginme2]

Maybe PrEP should be available in male prisons, as well. I dunno, but could image there is some transmission happening there...

Actually, I just read an article that US prisons have pretty outstanding treatment record.  All patients with HIV receive treatment.  The problem was trying to keep them on medication when they got out of prison.  Different topic though.

With a 100% treatment rate! there is probably little transmission going on.

[mecch]

Do prisons force HIV+ people to take pills? What is 100% treatment? 100% of HIV+ people or 100% of HIV+ people who want/need treatment?

[tednlou2]

A friend discussed this on Facebook tonight.  Another friend posted the article about recommending PrEP for those at risk.  He said his family doc didn't feel comfortable prescribing it and wanted him to see an infectious disease doc.  I hadn't considered that obstacle, although it seems obvious. 

Here in Louisville, there are just a few ID docs.  When I wanted to see about switching from the HIV clinic, I could only find like 4 other docs here.  And, I just learned two of those closed their practice and are only seeing patients in the hospital.  When they were in practice, they didn't take anyone with Medicare or Medicaid, so that knocked out many.  So, I thought tonight where are all these folks going to go for PrEP?  If a mid-sized city like Louisville only has a couple private practice ID docs, then I know smaller towns won't have them.  If they do, they will be handling those who have HIV and other infectious diseases.  Our HIV clinic could possible start to see neg patients, to help prevent them from having to come their as HIV patients.  But, they would have to hire more employees.  Well, depending on the demand.  There are times I'm there and the waiting room is full.  Most times, it just me or one other person.  So, I'm not sure how flooded they are with patients. 

Perhaps this will become like family docs prescribing depression meds, which use to be something only psychiatrists did.  I know there is controversy on family docs prescribing depression meds, with many believing it should still be done with a therapist and psychiatrist.  Maybe more family docs will become educated about this and feel comfortable prescribing.  I know many HIV patients have their family doc handle their HIV care.  If not, I'm not sure how many will get a referral to an ID doc, if they can find one anyway.  Will insurance pay for an ID doc, if the patient doesn't actually have an infectious disease? 

Anyway, just something I thought about tonight, which had not occurred to me until now.