So some panel at the FDA just approved this antiretroviral drug, Truvada– they say its okay to prescribe this drug for HIV negative people to keep them from getting HIV.
Im going to this news the nicest way possible:
I think there were a lot of MDs, and very few PhDs, on this FDA review panel. If you know what I mean.
I have been over this before–
–Prescribing an antiretroviral to negative individuals to prevent HIV is a neat idea. When it comes to this particular antiretroviral, it appears to be a very stupid idea. It has life threatening side effects, it has been shown to have a positive effect on some populations in one study, it has been show to have absolutely no effect in others. And then its ridiculously expensive– $11K a year.
Know what we *know* works, has no adverse effects, and is dirt cheap?
So we are going to give these drugs to people who dont need them (wear a goddamn condom), while people who *do* need them (HIV+ individuals) are having their coverage cut domestically and abroad, and then there is this minor thing we have to deal with with HIV… DRUG RESISTANCE.
You have to take drugs like this *religiously* for them to have the best chance of working (and even then, drug resistance develops). Ask any chick on The Pill, anyone who has to take blood pressure meds every day, or hell, even when you are on antibiotics for a week for a UTI or something– everyone forgets a pill now and then. Lets imagine what happens if you forget a pill if youre taking antiretrovirals to prevent HIV infection– you forget one pill, take one the next day, whatevs. Not whatevs. If youre exposed to the virus, it will be replicating in non-therapeutic levels of the antiviral. You will be selecting for variants of the HIV quasispecies that are resistant to the virus. In the mean time, youre thinking ‘IM TAKING ANTIRETROVIRALS! IM FINE!!!’ and not regularly getting tested for HIV. So HIV gets to thrive and have a great time, even in the presence of Truvada. And then you have sex with someone else “IM ON THE HIV PILL WE CAN TOTALLY BAREBACK IT!!! **HIGH-FIVE**” and you transmit a highly fit, drug resistant variant of HIV to someone else. And now they cant use some kinds of antiretrovirals because they wont work.
There is *one* instance where I think this is a good idea– if you have got a genetically vain HIV discordant heterosexual couple who have threatened to kill themselves/everyone if they dont conceive a child together. And even then, only when they are trying to conceive. And even then, only with an antiretroviral that is proven to work for these purposes (the Truvada trials that were stopped were with heterosexual women).
In all other instances, this is a TERRIBLE idea.
JUST WEAR CONDOMS.
JUST WEAR GODDAMN CONDOMS, PEOPLE.
And its not just me–
“Truvada needs to be taken every day, 100 percent of the time, and my experience as a registered nurse tells me that won’t happen,” Karen Haughey told the panel. “In my eight years, not one patient that I’ve cared for has been 100 percent adherent.”
The AIDS Healthcare Foundation, which opposes approval of Truvada, estimates that 20 HIV-positive patients could be treated for the cost of treating one patient with preventive Truvada.
This is stupid.