A Blue Pill Is Stopping HIV, World-First Study Shows | Hacker News Reader

A Blue Pill Is Stopping HIV, World-First Study Shows

bloomberg.com

130 pointsstartupflix89 comments

The effectiveness of the tenofovir and emtricitabine combination is hard to overstate. Other studies show almost 100% prevention of infection; to my knowledge there have only been two recorded infections in people who were reliably taking PReP, both of which were due to unusual, rare mutations.

This sort of thing is a step change for vulnerable populations; hopefully it ends up being widely accessible. The combination of this and aggressive testing and treatment reigimes means that there’s a real possibility of getting close to zero new HIV infections in Western countries.

Yeah this is true. The cost of generics is so low but in the United States it remains quite expensive if you don’t have insurance.

Even with insurance, the cost of essential drugs is too high. Our whole healthcare system consists of the care providers billing crazy, unjustifiable amounts to Insurance, followed by insurers paying out a percentage of that.

Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.

> Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.

It would, but Medicare would never agree to that, because it would cut off a major source of indirect revenue for them.

Medicare is not a decision making body. What are you talking about?

> Medicare is not a decision making body. What are you talking about?

CMS absolutely is a "decision making body", with direct authority over a whole number of matters.

But even beyond its office authority granted by Congress, Medicare (both the people who run it and the people who generally support it) are incredibly influential as well, and they would use that influence to block any policy that would affect Medicare so negatively (even if it would be good for the public at large)

> but in the United States it remains quite expensive if you don’t have insurance.

Not really - Gilead provides assistance programs for people who have private insurance, for people on public insurance, and for people who are uninsured (there are three separate assistance programs). The plan for people who have private insurance is the best (you end up paying $0/year for PrEP), and the plan for people who are uninsured is pretty good (not $0/year, but still pretty affordable).

Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.

> Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.

The sticker price is meaningless. Because of the assistance programs, nobody needs to pay it, whether you're on private insurance or uninsured.

Serious question: what's the point of the sticker price then? Surely someone must be paying it, right?

If not, why not lower it for -- at a minimum -- a PR boost?

It might be used as a starting point for negotiation with private insurers.

The sticker price is negotiating leverage for use against organisations with money, the insurance companies and Medicaid and Medicare. They don’t pay the sticker price either but they come much closer because they’re price insensitive. All costs get passed on, on average to the actuarial customer.

The manufacturer charges a higher price to the insurer and pays for the consumers copay so they are not impacted by price sensitivity. Kind of like business travels tend to spend more because it is the companies money vs their own. If the copay is too high, consumers might shop for cheaper alternatives instead of the "latest and best".

In addition to what other commenters have said, when you write off donated units, they're worth more at that time if their price is higher.

I have personally paid $1700 out of pocket for a month’s supply of PrEP, despite insurance AND membership in Gilead’s “advancing access” co-pay assistance program.

Gilead intended the program to cover about $300/mo, in order to cover your co-pay until your deductible is satisfied. That worked fine until this year, when UnitedHealthcare decided to re-class my card from co-pay assistance to a “manufacturer’s coupon” — thus accepting Gilead’s money while it lasted but still expecting me to pickup the full tab until my deductible.

The prices were similar here in Australia, friends who are on it were given instructions by their doctor on websites in South Africa and a particular brand name to purchase along with a prescription to get around it. Generic version but equally as effective. I believe now it is on the PBS here!

> to my knowledge there have only been two recorded infections in people who were reliably taking PReP, both of which were due to unusual, rare mutations.

The number is actually six, but given the number of people who've been taking PrEP since it was FDA-approved in 2012, that's still an impressive number.

The reason emtricitabine and tenofovir disoproxil fumarate work well together is because the primary known mutation that makes HIV resistant to the latter also increases its susceptibility to the former. There's a analogous situation in reverse with the primary mutation that provides resistance to emtricitabine.

PrEP is effective because strains of HIV that are resistant to both drugs are very rare, and also because most people who have resistant strains of HIV are on ARV treatment, which suppresses the viral load to the point where they cannot infect anyone else anyway (even without PrEP).

What is the possibility of more widespread drug resistance as the HIV strains that exhibit immunity are selected for?

Can someone provide a compelling argument for why we should not keep charging ahead given this risk? It seems to me that drug-resistant HIV would maintain the status quo, but I don't really know anything about the landscape of drugs/resistance in HIV

> I don't really know anything about the landscape of drugs/resistance in HIV

HIV is a retrovirus with an absurdly high mutation rate (4 × 10−3 per base per cell, Cuevas, J. et al, 2015). In comparison: the mutation rate of influenza is about one or two orders of magnitude lower. This means that it is incredibly quick to adapt to any changes.

There have now been six: https://www.out.com/news-opinion/2018/10/09/sixth-case-man-c...

Developed by Gilead, the same company that created the Hep-C cure Sovaldi. Some kick-ass work there.

Have been googling Solvadi. Wow, curable hepatitis c is a big achievemt. But it‘s insanely expensive. It has to be taken daily for at least 12 weeks, with each pill costing 400€! The chance of curing is at 90%.

That sounds pretty inexpensive. It looks like the previous standard of care cost $10-15,000 and wasn't generally curative. Meanwhile, the long-term cost of a progressing hep-c infection is quite high.

In the context of a decietful medical system that bills pie in the sky amounts for rendering basic care, a $100k cure for Hepatitis C might seem reasonable. But those who need it most are dying due to this pricing scam, which is standard for our healthcare in the US.

> But those who need it most are dying due to this pricing scam, which is standard for our healthcare in the US.

Those who need it most are dying not due to the "pricing scam", but because they're incarcerated and therefore prohibited from receiving curative HCV treatment, at any price.

The sticker price is high, but it's meaningless, because almost nobody is going to be paying the sticker price.

Also, if you want to make a statement about healthcare pricing in the US, Sovaldi is literally the worst example you could pick. For the first few years after it was available outside the US, Sovaldi was significantly cheaper in the US than in it was elsewhere.

There are 3 million people living in the US with Hepatitis C, many who are needlessly dying from it are not incarcerated. The sticker price is a scam to make insurers feel good when they get double digit percentage discounts, while still lining Gileads pockets.

I'm sympathetic to the argument, but it doesn't have much to do with my point, and I'm more interested in the economics of new therapies than I am in a moral or political debate about how medicine is financed.

What's your alternative then?

> There are 3 million people living in the US with Hepatitis C, many who are needlessly dying from it are not incarcerated.

I was responding to the claim about people who need it the most. People who are incarcerated are, in fact, the people who benefit from curing HCV the most. And the price is not the reason they are unable to access it.

> The sticker price is a scam to make insurers feel good when they get double digit percentage discounts, while still lining Gileads pockets.

Even if you subscribe to the absurd notion that massive insurance companies incentivized by their bottom line could be oblivious to that dynamic and content with "feeling good" about an imaginary discount that lines their vendor's pockets, this argument falls apart when you look at how much the same medication costs in countries like Germany and France.

Sovaldi costs about the same over there, and in fact, used to cost more than it did in the US (in addition to receiving approval much later than they did in the US).

Who are these dying patients, can you elaborate?

It was $100k per course at the time of introduction in the US, which resulted in a lot of hate. But it is a miracle. A close relative of mine was cured, and it had a profound effect on her quality of life. Gilead has very different prices in different regions, we sourced from a place that was much cheaper.

Since your relative is cured, I don't think there's any harm in telling us what country you sourced the drug from.

India.

Move to a poor country and get a compulsory license for a local producer via a WTO procedure. This has been possible since the TRIPS agreement.

Gilead deserves a lot of credit for their work on HIV.

The credit on the hepatitis C cure and Sovaldi goes to the scientists at Pharmasset of Princeton NJ. Gilead bought the company when it became clear what they had, and then more than doubled the price Pharmasset was planning to charge for Sovaldi.

https://en.wikipedia.org/wiki/Pharmasset

Interestingly, one of the principles behind Pharmasset, the scientist Raymond F. Schinazi, was born in Egypt. Egypt has one of the world's highest rates of hepatitis C infection. Egypt unintentionally gave itself a hep-C epidemic - while trying to fight another public health threat - that reached over one in ten people. Generics, post Sovaldi, have dropped the price of treatment down to $84 per patient, with Egypt now making rapid progress against hep-C.

https://www.theatlantic.com/health/archive/2018/05/why-egypt...

Since April 1 2018, PrEP is subsidised by Australia under the Pharmaceutical Benefits Scheme (PBS). Thus, it costs $39.5 per script ($6.40 concessional rate) [0, 1]. Earlier, it could cost as high as $10,000 a year [2].

[0] https://www.healthdirect.gov.au/blog/Anti-HIV-drug-PrEP-to-b...

[1] https://www.healthdirect.gov.au/pharmaceutical-benefits-sche...

[2] https://www.theguardian.com/australia-news/2018/feb/08/hiv-p...

For me the biggest surprise in the article is that there are 180,000 men in the United States on Prep. Given a back of the envelope calculation of 4.8m out gay men in America (3% of population) that means adoption is itself around 3%.

Somehow I imagined truvada was more widey adopted but perhaps it is just heavily marketed on the east coast.

In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

> In the US, there is big money to be made bilking insurers and citizens for as much money aas possible with crazy drug prices. This is what funds most of the ads we see for PreP, and also makes this treatment inaccessible to those who need it most.

This is wrong on so many levels.

Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts.

Secondly, Gilead (the manufacturer of PrEP) pays for the copay of the drug, up to a pretty high cap which is actually hard to reach under all non-catastrophic health insurances. That means that most people in the US who are on PrEP are eligible to pay literally $0 out-of-pocket. In other words, PrEP is literally cheaper for most Americans than it is for people in other countries, because every other country charges at least a nominal fee for the drug.

> Most of the ads you see aren't funded by Gilead, or by any pharmaceutical company at all. They're funded by local agencies and nonprofits tasked with HIV prevention efforts.

This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising.

In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.

> This differs significantly from what I see, the local agencies in my area are focused on providing testing, care and treatment, not funding advertising.

Sounds like your local agencies either aren't doing their jobs or aren't spending their money appropriately. Public service announcements are an important part of public health in every country. Dissemination of public health information and knowledge of what resources are available doesn't happen by magic.

> In the latter half of your comment, you literally described how this is set up to scam insurance. If one has insurance, everything is great, otherwise they get stuck without medication they need.

"the copay with insurance is less than the out-of-pocket expense without insurance" is not, in se evidence or a description of a scam.

Anecdotally, usage is highly regionalized, and is generally met with cultural resistance leading into exceptsnce per area. I started using it in San Francisco I’m 2013, before it was completely normalized. It has spread from major metropolitan centers and is going through the process of acceptance in smaller towns. A (somewhat sarcastic) call to put truvada in the municipal water supply is generally appreciated in the bay, but when I visit smaller mid-western cities these days there is still a lot of anti-prep sentiment. It has however achieved a reasonable amount of acceptance in regional hubs.

There are side-effects of PrEP for long-term use. It can cause kidney damage. So it's not an entirely risk-free magic pill.

It's still much safer to only have sex while in a monagamous relationship where you and your partner have been tested for HIV. And checking test results before having sex with someone is also a very safe practice that is really common. But in the end if you're often sleeping with people who you don't trust, PrEP can be worth the risk.

> It's still much safer to only have sex while in a monagamous relationship where you and your partner have been tested for HIV. And checking test results before having sex with someone is also a very safe practice that is really common. But in the end if you're often sleeping with people who you don't trust, PrEP can be worth the risk.

Please stop spreading anti-PrEP misinformation.

Statistically, it is literally safer to be on PrEP and have multiple partners of unknown status than it is to be in a monogamous relationship and not be on PrEP.

Actually I've been googling around since you've said this, and I can find WHO and CDC booklets indicating that PrEP is generally safe. In fact, the WHO indicates that PrEP is as safe as placebo in the populations that have been studied.

http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_H...

It's interesting because some of the gay men I spoke with about PrEP seemed to think there were significant risks of kidney damage from long-term use. I wonder where they got their information from.

There is risk for some men, but at least here, you go in regularlynfor checkups to ensure there are no problems. Only a small number have the side effects, and these discontinue treatment.

Graph seems to be comparing 6 months of 2018 with full years before that which would vastly overstate the decline.

This is misleading to the point that I would consider this lying to the audience. It's just wrong to convey the data in this way. The note below the graph does not make this OK.

If anybody is interested in the actual data, I think the data is pulled from "NSW HIV Surveillance Data Reports": https://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data...

Yep, look at Figure 1: https://www.health.nsw.gov.au/endinghiv/Publications/q2-2018...

The trend seems to be downward, but it's more like ~10% in the past couple years than a step change.

Thanks, I overlooked that myself, and is definitely misleading.

Interesting problem we're dealing with: Truvada potentially makes it harder to identify HIV+ blood donors (as their antibody titers fall naturally over time) and raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". It is a well-known fact in their community that men having sex with men are deferred from being blood donors for 12 months from last male intercourse, and there is at least a vocal minority in the community which feels this is unjust. Presently, there is no approved question for the donor questionnairre along the lines of "Are you using Truvada?" but it is a hotly debated topic among blood bankers.

Is there any centralized ruling for this in the US (and other countries) or is this up to the blood banks.

I'd imagine they'd face liability issues if they were taking blood from high risk individuals. This also applies to intravenous drug users as well (which has nothing to do with sexual orientation).

Each donor center medical director is responsible for their own checklist, however, The American Association of Blood Banks (AABB) inspects blood donor centers and publishes their questionnairre. Not asking these questions will constitute a hit agaisnt your program and may jeopardize your institution's ability to seek reimbursement for services from, say, CMS.

http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%2...

Truvada does nothing to change identification of HIV+ donors. Truvada does not change response to HIV tests, an HIV+ person taking Truvada as part of treatment does not stop testing positive for HIV antibodies. Nothing changes from the existing blood donation situation due to Truvada.

Like most things in science, be suspicious of pure logical arguments. The question for any test, even a true-false, is first a matter of "how much". Antibodies fade over time, ergo various vaccine boosters, such as tetanus. At some point, we can't detect it.

I don’t know why is this being downvoted.

Anti bodies are produced to combat a pathogen if the levels of the pathogen are below of what would trigger the immune system you will not produce anti bodies and the ones that you have had produced will fade of over time you don’t have anti bodies for every pathogen you encounter flowing through your blood that would likely kill you.

If the pill can reduce the virus to trace levels and prevent HIV from developing into AIDS it’s not unreasonable to question if it can affect current HIV detection protocols.

Heck it wouldn’t surprise me if they measured the levels of anti bodies dropping while the levels of immune cells remaining normal to test the efficiency of the new drug.

That said I know some HIV tests check for the levels of virions in the blood these are often used for AIDS prognosis I don’t know how sensitive these are and if they’ll be able to detect trace levels of the virus if anti bodies response tests will become unreliable.

Also like with everything it’s not binary if this new treatment regiment can reduce the effectiveness of HIV testing by any meaningful margin it will be a problem.

I have very hard time believing that current HIV testing is 100% false negative proof.

The pill was already part of HIV trratment, it does nothing to change the effectiveness of HIV tests.

The only unknown would be whether if you are one of the very, very few people that manages to contract HIV while taking prep, your antibody response is different during that initial window.

But: Anyone in that situation is already covered by the questions about recent partners and already is not donating if answering the existing questions in good faith. If they are donating in this situation at all they are already just ignoring the questions.

>The pill was already part of HIV trratment, it does nothing to change the effectiveness of HIV tests.

Where is that stated?

>But: Anyone in that situation is already covered by the questions about recent partners and already is not donating if answering the existing questions in good faith. If they are donating in this situation at all they are already just ignoring the questions.

I think you missed the entire point of the GP this isn’t about someone acting in good faith or rationally.

> If the pill can reduce the virus to trace levels and prevent HIV from developing into AIDS it’s not unreasonable to question if it can affect current HIV detection protocols.

It is, because

a) we're talking about PrEP, a treatment for HIV- people

b) Truvada has already been used to treat HIV+ for the past ~15 years.

c) HIV screening for blood donations uses antibody testing, which has nothing to do with viral load.

It's not a pure logical argument. What you are describing has never been observed though in anyone taking any type of antiretroviral therapy in the now 20+ years of the HAART era. This is a completely unfounded what-if.

The donors you don't want donating are already excluded by existing questions. And if you are that concerned about completely hypothetical unknowns then you might as well also not trust any of the batch testing done on the donors blood anyway. The questions can only ever be a useful prefilter, not a perfect safety net.

> The question for any test, even a true-false, is first a matter of "how much".

So if someone asks "Does strawberry intake affect HIV antibody tests?", the answer isn't "no"?

Welcome to research and statistics. The most accurate answer is probably something like: "the effect of strawberry intake on HIV antibody testing is not significantly different than zero based on current evidence". There very well may be an effect it's just so small we can't tell it from the noise.

>raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe".

What? This sounds like completely made up scaremongering. Why wouldn't they just get their viral load tested?

Thinking of remote possibilities and assuming your patients could be lying to you (corollary: trust but verify) is pretty standard practice in medicine.

and your solution to these adversarial patients that are willing to lie is to... ask a second question?

Whether Bayesian or Frequentist, surely you can agree the result of different tests are unlikely to have 100% concordance.

> there is no approved question for the donor questionnairre

Do they not already ask if someone's ever been diagnosed with asthma, hepatitis, HIV, leukemia, lymphoma, myeloma, etc? All of which are permanent disqualifications.

As a gay man on prep, I find this comment quite offensive.

Within my circle of friends (some of whom are quite adventurous) none of them says “let’s donate blood and see what happens”.

Furthermore being on PrEP requires strict complete STD testing (Chlamydia, Syphillis, HIV, included) testing every 3 months before allowed to be prescribed again. The same time interval as any recommended STD testing.

I had a discussion with my Dr last week about Truvada on similar topic. Her reply was that Truvada is not enough to suppress viral load and thus they can be detected if a person is infected still and is not on treatment. Also Truvada is not magic pill and can take time to take effect (about 1-2 weeks) and there have been cases of people getting infected while on PrEP because their drugs haven’t taken effect yet.

And yet STD rates are skyrocketing in the US. I take Truvada but it’s used as an excuse in the gay commmunity to engage in unprotected sex. If anything the availability of Truvada is probably a leading cause of why STD rates in the gay community are increasing.

> STD rates are skyrocketing in the US

Source? (If frequencies of curable STDs are rising while those of incurable ones are falling, that would be a good trade.)

Edit: common STDs that are treated by antibiotics are becoming drug resistant like anything can be that is treated with antibiotics. Point is don’t think because you can take an antibiotic and make syphilis go away now that you won’t encounter a drug resistant strain now or in the very near future!

https://www.nbcnews.com/news/amp/ncna642161

Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, genital herpes, etc.

The recent year over year increase in STD rates in the US has been very well documented. https://www.nbcnews.com/news/amp/ncna904311

What are you talking about? There's cures for literally every single one of those diseases you mentioned.

Antibiotics aren’t going to work forever on new strains of common STDs. Already seeing rise in drug resistant strains.

https://www.nbcnews.com/news/amp/ncna642161

> Lol there’s no cure for syphillis, gonorrhea, chlamydia, hep b, etc etc.

Each and everyone disease you listed here can be cured. Example, Syphilis - https://www.cdc.gov/std/syphilis/lab/default.htm

Antibiotics won’t work forever. Seeing drug resistant strains already.

https://www.nbcnews.com/news/amp/ncna642161

> Antibiotics won’t work forever. Seeing drug resistant strains already

You said there's "no cure." That's different. Reducing frequencies of a disease for which there is literally no cure in exchange for higher frequencies of a disease for which there is emerging antibiotic resistance is still a good trade.

The article you cite regarding rising STD rates claims the cause is "a decline in funding for state and local agencies working on prevention" as well as "an extreme lack of awareness about STDs and sexual health" and "doctors are not screening and testing for these diseases and patients [not knowing] they need to ask to be tested" [1]. The only link to HIV stated is "people are not afraid of dying from HIV," not a link to prep.

[1] https://www.nbcnews.com/news/amp/ncna904311

If you have a link for the genital herpes cure you will be rich.

> If you have a link for the genital herpes cure you will be rich.

May never happen [0], but one can wish. Although it doesn't have a cure, the treatability, prevalence, and general harmlessness of herpes make it less of an issue than the "curable" STDs. Most doctors don't even bother testing for it [1].

[0] https://www.healthline.com/health-news/why-we-still-dont-hav... [1] https://www.cdc.gov/std/herpes/screening.htm

  general harmlessness of herpes

Perhaps you missed that HSV is a vector for cancers (e.g Kaposi sarcoma).

Kaposi Sarcoma is caused by HHV-8, a completely different virus than HSV-1/2. They are in the herpes virus family, but this is a huge virus group including eg chicken pox (HHV-3) and Epstein Barr virus that causes mono (HHV-4).

I have strong personal anecdotal evidence that casual hookups are much more upfront about condom-less sex and in fact I find that a shockingly high percent outright refuse condom sex (e.g. bareback only).

I'm not sure if the actual condom use rate is lower (I wouldn't be surprised) but in my experience the upfront non-condom attitudes is staggering and way higher than 10 years ago. Tech, attitudes, PrEP have shifted culture and depressingly for me lowers match rates from an already tiny population in my experience by more than 50% of guys on hook up apps !

> I have strong personal anecdotal evidence that casual hookups are much more upfront about condom-less sex and in fact I find that a shockingly high percent outright refuse condom sex (e.g. bareback only). I'm not sure if the actual condom use rate is lower (I wouldn't be surprised) but in my experience the upfront non-condom attitudes is staggering and way higher than 10 years ago. Tech, attitudes, PrEP have shifted culture and depressingly for me lowers match rates from an already tiny population in my experience by more than 50% of guys on hook up apps !

Condom usage has been dropping for decades. It began dropping before ARVs were discovered in the 90s, and it's steadily decreased in the years before PrEP was discovered as well. There are a lot of well-studied reasons for this.

So yes, you're right that fewer people are using condoms today than they were 10 years ago, but the correlation runs the other way. The search for a different prevention tool (which resulted in PrEP) was motivated by the fact that people have realized for decades that condoms were not going to be a viable long-term solution for addressing the spread of sexually-transmitted HIV.

Yeah for me the big change I dont think so much is actual condom usage but the up front attitudes. 10 years ago on hookup apps if you said 'bareback only' it would have been taboo to most. But now it seems like that's acceptable and a surprisingly large percent refuse condoms period which is crazy to me. Like for this percent of users sex with a condom is worse than no sex which is what's crazy to me..

> And yet STD rates are skyrocketing in the US. I take Truvada but it’s used as an excuse in the gay commmunity to engage in unprotected sex. If anything the availability of Truvada is probably a leading cause of why STD rates in the gay community are increasing.

No, STD prevalence is dropping. STD diagnoses are increasing, because PrEP requires more regular STD testing, which people weren't doing before.

Please stop spreading the anti-PrEP propaganda touted by people like Michael Weinstein. It is actively damaging to public health.

Honest question. The generics of Truvada are available in India for around USD$30 a bottle from a number of local Indian Pharma companies including Cipla. It would still be cheaper for Americans to travel to India on a budget flight and buy back a year's supply of these generics. Wouldn't US immigration allow importation of small amounts of medicine for personnel usage if you have a doctor's prescription?

https://dir.indiamart.com/search.mp?ss=tenvir-EM

There's a 50 dose limit, set by the Customs and Border Protection Agency when bringing drugs back into the US, without a US prescription. There are some exemptions for bringing prescriptions in from Canada and Mexico.

The FDA has its own rules, set at a three month supply, requiring a prescription, and the drug must be legal in the US. You'll see conflicting reports on whether you can get through customs with a three month prescription.

For example here, from the FDA:

"Travel with no more than you need for your personal use during your stay. A rule of thumb: Bring no more than a 90-day supply of medication."

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm484154.h...

Does that apply only to foreigners, to US citizens, both? Who knows, their own information across agencies seems conflicting and confused. They're probably all unsure of which agency actually has final authority at this point, and or they each probably think their agency does.

That said, every year millions of Americans bring in illegal prescriptions regardless. If you're desperate enough and the savings is high enough, why not try it within reason (stopping short of some large cache that gets you tagged for smuggling that is).

From what I've read previously, this isn't a surprise - PrEP is expected to make a huge impact where it's available and this study sounds like it could be very influential in getting it made available elsewhere which is, I think, its real value - the public health effect rather than the individual-level effect.

The article linked below also details some of the pitfalls campaigners had to overcome to get it funded on the NHS in the UK - the biggest hurdle was not convincing people of effectiveness but that there was a need in the first place - as safer sex is much cheaper but in practice just doesn't always happen and we're probably at, or close to, the limit of what education can achieve now.

https://www.bbc.co.uk/news/stories-44606711

Corroboration from a more reliable news source than Bloomberg: https://m.indiatimes.com/health/buzz/this-blue-pill-has-been...

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