US FDA approves Gilead's twice-yearly injection for HIV prevention | Hacker News Reader

US FDA approves Gilead's twice-yearly injection for HIV prevention

reuters.com

Who will take this drug? Every sexually active person? Would insurers pay for prophylaxis?

Insurance (at least some) do pay for oral HIV prophylaxis (in the US)

It’s part of Obamacare, all insurances (with small exception) are required to pay for HIV prophylaxis for vulnerable populations (I.e gay or the ones having sex with multiple partners without condom, so basically everyone who needs it).

Couples with one infected partner, I suppose.

I can think of a few cases where this would be a good idea. IV drug users, those engaging in risky sex, sex workers, hospital workers after accidental exposure, HIV positive mothers, those with drug resistant HIV, people with HIV positive partners, and anyone who cares to.

Honestly some of the people that would benefit the most probably aren't going to be taking this. E.g IV drug users, sex workers, and people engaging in risky sex might not be the people that are likely to proactively seek this out. A decent subset of this population probably will use this but a sizeable proportion won't.

Non profits, clinics, outreach NGOs who work with them will educate and get them access.

People engaging in risky sex are already the main target market for PrEP.

Anyone at risk of exposure.

https://hivinfo.nih.gov/understanding-hiv/fact-sheets/pre-ex...

thanks for that link.

if you are HIV negative, have had anal or vaginal sex in the past 6 months, and:

  Have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load), or
  Have not consistently used a condom, or
  Have been diagnosed with a sexually transmitted infection (STI) in the past 6 months.

This is a very, very high number of candidate patients! Anyone who inconsistently uses a condom. "During 2011–2015, 14.8 percent of women and 19 percent of men aged 15–44 reported that they used a condom ‘every time’ they had intercourse in the past 12 months,” the NCHS team wrote in their report." [1]

[1] https://www.nbcnews.com/health/health-news/third-u-s-men-use...

A wide net can be cast, but broadly speaking, you’ll want to start with your highest exposure and compliance (having to take a pill everyday is not great) risk patients first and work your way down as you scale up manufacturing and last mile infrastructure. Daily pill users turn into twice annual injection users, healthcare workers who could receive the injection at the workplace, etc.

This should, in theory, cause the infection rate to rapidly decline when you disrupt the most common and frequent transmission vectors. The slow long burn is going to be upkeep on all of this until HIV is eradicated (similar to the last days of a disease due to sufficient vaccination uptake, think smallpox).

My guess is that it's cost effective to pay for prevention.

The social case for heavily subsidising (if not making free) preventative care and treatment for any contagious disease is strong.

It gets trickier given existence of alternatives (and what’s important generic alternatives).

It doesn’t. Communicating it does. But this sort of goes to the heart on why republics outperform pure democracies.

Just to be clear by alternatives I mean currently used oral prep pills: truvada (which is available generic) and descovy, both from gilead. Both are 1 pill a day, with truvada available in a regime where you basically take it only for couple of days before and after high risk activity. And most importantly it can be cheap since it’s generic.

This thing is cool but it would be even better if it didn’t cost a fortune.

> My guess is that it's cost effective to pay for prevention.

Is there any prevention with this vaccine ? Or you will make an "lighter type" of disease as with other viruses ?

Mostly men who have sex with men.

Most gay men will

Everyone currently taking PrEP I would think. As long as it's cost competitive and accessible. Having to take a shot every 6 months is a hell of a lot more convenient and reliable than having to take a pill every day.

Gay men for the most part. Prostitutes hopefully.

Here in Spain people in risk groups can get it from the government. No insurers necessary (personally I don't even have health insurance other than the state system)

This is amazing news. It'll make some people very mad though, but hell yeah.

This is awesome news, with a lot of the recent news I was worried this was not going to happen or we would get some stupid fear mongering (or some puritanical reason used).

Now the real question is insurance. Is this cheaper than the pills?

To my knowledge even the previous injections were hard to get insurance to pay for given how cheap you can get truvada since its generic.

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