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Comment by gschizas | Hacker News Reader

I'm a little wary with "100% effective". Not even 99.9% effective?

Not a great title, it would seem:

> provides HIV-negative individuals around 99% protection from contracting the devastating virus through sex

Not a well written article in other ways too. What's the booster interval? What's the expected market coverage? How expensive is it, especially in poor countries where it's needed most? Are there challenges in transportation or storage that will limit its adoption? How does its efficacy as a preventative compare to its efficacy as a treatment (the reason it was approved in 2022)? Lots was left unsaid by this article.

You'll note also, the sole source for the article is Gilead (mentioned at the end), the drug manufacturer.

These are better covered by Gilead’s actual press releases, of which this is a very poor summary.

For pricing, Gilead will likely carry over its policy for Truvada, by charging fairly high rates to western countries (with vouchers available) to subsidize its operations in Africa, where it will be provided cheaply or freely.

(Disclosure: I’m an investor. I truly believe that if any company can be morally good, Gilead qualifies.)

https://www.gilead.com/news/news-details/2024/gileads-twice-...

https://www.gilead.com/news/news-details/2025/gilead-finaliz...

https://www.gilead.com/news/news-details/2025/gilead-receive...

> I truly believe that if any company can be morally good, Gilead qualifies.

The primary reason Gilead exists in my memory is the headline years back about their exorbitantly high prices for a life saving hepatitis C drug and the resulting questions this was raising in congress ($84K for a 12 week supply) [0].

While it may be admirable that they are providing these drugs freely to countries in need, I’d be more hesitant to accept at face value the claim that US prices in particular are somehow reasonable on that basis. I also question the framing that those high prices are necessarily high. I’m less familiar with how they’ve priced things in recent years.

- [0] https://news.ycombinator.com/item?id=7529435

Do you know how much a liver transplant is? That was the alternative.

They created a way to live with AIDS. They were the first. They did it in the 90s, where even working on this had significant stigma still. Friends are alive because of them.

Wikipedia says:

In 2024, lenacapavir was named the "2024 Breakthrough of the Year", citing its "astonishing 100% efficacy" in one large efficacy trial in women to prevent HIV and "99.9% efficacy in gender diverse people who have sex with men,"

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

It's curious that the article (and wikipedia) specifically refer to sexual acquisition.

Wouldn't sexually active people who have sex with men be the primary market? It makes sense this would be the focus of the drug's development.

They may also have issues trying to conduct robust clinical trials with IV drug abusers. If a subject entered rehab or were incarcerated for a period of the trial, would that invalidate their data? I don't know enough about the subject but it intuitively feels like it could present a real challenge.

Prep has been studied for IV drug users. It works, enough that it is recommended, but is much less effective. IV drug use is a massively more efficient transmission route than any type of sexual contact.

>IV drug use is a massively more efficient transmission route than any type of sexual contact.

Yes, and people who take IV drugs are much less likely than men who have sex with men in general to take a pill daily.

Asking here instead of searching, for conversational purposes:

In the 90s, some STD training I took said it was highly unlikely for otherwise healthy bio women to contract HIV from a man (ie compared to sex trafficked women in poor health), with the claim that vaginal sex is less susceptible to micro tearing that allows easy transmission than anal sex is.

I didn’t really question this at the time because it seemed plausible and I believed the people who were telling us this. (Note: this was in a medical context, not someone trying to scare us.) Is there any credibility to that idea now that we have more data, and hopefully leased biased science than we had in the 80s?

It's true that it's less likely, but calling it "unlikely" is grossly irresponsible. Yes, the chance is only 1-2%, but that's per vaginal sexual encounter. (And it's also "only" 20% for anal.)

https://stanfordhealthcare.org/medical-conditions/sexual-and...

https://pmc.ncbi.nlm.nih.gov/articles/PMC3412216/

Yeah, agreed. That was the takeaway 3 decades ago, and I only bring it up no out of curiosity of how erroneous that turned out to be. I’d hope no one would describe it that way today.

That doesn't match what the top study says: 1.4% for anal and 0.08% for vaginal.

> The analysis, based on the results of four studies, estimated the risk through receptive anal sex (receiving the penis into the anus, also known as bottoming) to be 1.4%.

> It is estimated the risk of HIV transmission through receptive vaginal sex (receiving the penis in the vagina) to be 0.08% (equivalent to 1 transmission per 1,250 exposures).

Ah, you're right. I pulled a totally unrelated statistic. Complete nonsense to say that it's unlikely for vaginal sex.

In the fog of the day, you can understand why 1 transmission per 1,250 occurrences qualified as unlikely. Female prostitutes were self-reporting that they didn't use condoms and weren't showing symptoms. Meanwhile the disease decimated the gay male population which is why it was called GRID ("Gay-Related Immune Deficiency"). It was a complicated and horrible time and the data really wasn't there.

    Receptive anal 1.4%
    Insertive anal 0.06% - 0.62%
    Receptive vaginal 0.08%
    Insertive vaginal 0.04%

Seems to still be the case..

[0] https://stanfordhealthcare.org/medical-conditions/sexual-and...

Maybe the other routes simply weren't tested for. Sex is how most people get HIV, so it makes sense to start from here. The second most common is by sharing needles, usually by drug addicts, and I can't think of an ethical way of doing a trial in such conditions. The rest is mother-child transmission, which is irrelevant as the drug is not intended for fetuses, and the odd accident which is probably too uncommon to make meaningful statistics.

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