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Comment by CryptoPunk | Hacker News Reader

Just to be clear, a vaccine doesn't cure a disease. It prevents one from contracting it.

Also worth mentioning that while we don't have an exact "cure" for HIV, we do now have treatments that (if you or your country can and will pay for it) can make having HIV into something that not only doesn't ruin your live, but that even can't be spread from you to people you have sex with.

Getting to the parent comment though it's amazing how far we've come in that we already do have virtually 100% affective prevention from medicine. PrEP and the knowledge that non-detectible = non-transmissible.

I've been re-watching Queer as Folk which isn't that old and it's crazy how aged it feels because we've made so much progress over the last 10 years. BTW amazing show if anyone hasn't seen - wish you could get HD version with the original soundtrack.

QAF (US) was amazing - got them on DVD, and was the only way I could watch them ~ 15 years ago.

For what its worth, PrEP is not without its own costs. Besides the documented side effects, it also seems to rapidly accelerate cellular aging.

I have the DVDs too. It's worth the lower quality just for the music. Some of the most powerful scenes are deeply tied to the nusic for me, dancing at prom, Brian's bowling, the first episode, so many more - the replacement 'music' they hacked together is horrible too...

Wow i didn't know the cellular aging part thank you. Do you have anymore info? I'm on it (or was when I could actually be around humans ;( )

The biggest downside I know about is the cost. It's insane even though i have really great insurance. Gilead does reimburse but it takes like 6 weeks or more. A low income person can't be out almost 2k for that long. Medicade/care is also a pain especially those most at risk, IV users, etc. Hopefully I've heard it goes generic soon.

I feel like we are 5-15 years away from being able to eradicate or relegate sadly to the developing world only.

The music on the show deeply influenced my musical tastes for at least a decade. The most moving scene for me personally was Brian bicycling by himself (S04E14) - for the longest time I would get weepy just thinking about it, and how it seemed to reflect where my own life was at the time. The music really tied it together - Wonderful Life by Colin Vearncombe.

The cellular aging - it's something I discovered recently myself, when it was mentioned in passing during a talk on aging. I did some reading and I think this is it:

* [Brief Report: Differential Effects of Tenofovir, Abacavir, E... : JAIDS Journal of Acquired Immune Deficiency Syndromes](https://journals.lww.com/jaids/Fulltext/2017/01010/Brief_Rep...)

* [Tenofovir disoproxil fumarate induces peripheral neuropathy and alters inflammation and mitochondrial biogenesis in the brains of mice | Scientific Reports](https://www.nature.com/articles/s41598-019-53466-x#Sec24)

* [Pharmacogenetic Analysis of the Model‐Based Pharmacokinetics of Five Anti‐HIV Drugs: How Does This Influence the Effect of Aging? - Chen - 2018 - Clinical and Translational Science - Wiley Online Library](https://ascpt.onlinelibrary.wiley.com/doi/full/10.1111/cts.1...)

Accelerated cellular aging has been noticed in HIV+ patients for a while, and there is some growing evidence that at least some of it might be due to ART, including the formulations used in PrEP. I'm not aware of a study looking at accelerated aging in HIV -ve people using PrEP.

I suppose the risks are elevated with the daily dose regimen, and Event Driven PrEP (2+1+1) might be safer long term. Of course, Event Driven PrEP recommendations also assume fewer than two sexual encounters per week, so it's not for the more 'social' amongst us.

I'm unfamiliar with the pricing. How much is the out of pocket costs? Does Gilead reimburse the entire copay?

thanks!

HN is amazing sometimes ;)

I was 17/18 just becoming independent in college when I discovered the show and it gave me so much confidence.

'No excuses. No apologies. No Regrets", "F*ck em all", or Justin's self actualizing speech to his therapist and mom that I won't repeat here lol.

Yeah Gilead will reimburse all the copay. I guess so they can charge insurance/government an insane amount. Which is passed along to us anyways...

I think it was like $2000 out of pocket for me for 3 month supply. and i have really really good insurance.

Yeah the one dating experience i have had in covid that actually progressed I used that short time frame dosing.

Though in normal times for most PrEP users it would seem impossible to schedule sex in advanced or too frequent to do that.

But still really good research on how effective these drugs are. maybe we'll get more research into short term PeP - though i think that's a different drug combo.

Any idea if Descovy is similarly reimbursed by Gilead?

maybe: https://www.descovy.com/treatment/co-pay-assistance

That's what I'm curious about too (just an engineer with no medical degree). There are a lot of viruses that are simply undetectable by our immune system so it never triggers a response (similar to cancer). A good example is the herpes family. I was under the impression that you can't fully cure herpes because it hides in your nerve cells. I wonder if mRNA can force an immune response to cure this.

Some vaccines are also cures.

In the case of HIV, the problem is not that the body is unable to properly respond to the disease, the initial infection is usually benign and the immune system produce the antibodies necessary to fight it, that's what being HIV+ means.

Problem is, HIV mutates so quickly that the immune system is essentially playing whack-a-mole and cannot eradicate the virus completely.

A vaccine that imitates a real infection perfectly is mostly useless, because it will train the immune system on the wrong mutation.

The trick here is to focus the immune response on parts of the virus that don't change, by using mRNA that only produce these parts.

It is like telling the body what the weak point of the virus is. It is useful both before and during the attack.

HIV does not mutate in the body. Viruses mutate over tens of thousands or millions of patients. It does not evolve within the space of a single person's infection and does not use mutation to evade the immune system.

Here's an article about HIV mutating in the body: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574155/

Influenza can barely even copy itself accurately.

Here's an old article highlighting escape mutations evolving within the span of a single person's infection.

* [HIV evolution: CTL escape mutation and reversion after transmission - PubMed](https://pubmed.ncbi.nlm.nih.gov/14770175/)

In case of HIV, though, it may also (partially) replace medication, considering that the virus is hiding from the immune system for a while.

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