Drugs May Offer AIDS Prevention

FlipFlopSnowMan writes "There is an interesting article on MSNBC about the possibility of preventing AIDS using the same pills that are currently used to fight the virus in affected individuals." From the article: "The drugs are tenofovir (Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by Gilead Sciences Inc., a California company best known for inventing Tamiflu, a drug showing promise against bird flu. Unlike vaccines, which work through the immune system -- the very thing HIV destroys -- AIDS drugs simply keep the virus from reproducing. They already are used to prevent infection in health care workers accidentally exposed to HIV, and in babies whose pregnant mothers receive them."

Comments

Cash cow?

[Tx]

Q. How to make more money from expensive AIDS drugs?

A. Obvious - sell it to people who don't have AIDS as well as people who do.

As I understand, these drugs are very expensive, and personally I can't see any justification for using them prophylactically.

Re:Cash cow?

[Saulo Achkar]

...personally I can't see any justification for using them prophylactically. Get AIDS and you will find a justification....

Re:Ah, man..

[dario_moreno]

"odds are 1 in 10000"...rather 1 in 1000, and even more for receptive sex, and if you do it once a day, you get almost a 1 in 2 chance of catching it after 500 days. Check Chad Douglas on google...always on top, positive after 5 years, dead after 15.

Ummm...

[spaztik]

This is all well and good but...

In the United States, wholesale costs are $417 for a month of tenofovir and $650 for Truvada.

Who is going to be able to afford this stuff?

Save the melodramatic crap

[Fhqwhgadss]

What's with the qoute at the end: This is very promising. For us to be involved in a potential solution to the big HIV crisis and pandemic is very exciting.

Pandemic? Really? Tuberculosis affects far more people worldwide but doesn't have all the sensationalism that we see surrounding AIDS. I don't mean to imply that nothing is being done about TB, or that AIDS isn't a problem, but I'm tired of the media treating this disease like we're all living on the set of "Rent"

My father..AIDS! My sister...AIDS!
My uncle and my cousin and her best friend AIDS.
Gays, straights, whites and spades,
everyone has AIDS.
My grandma and my old dog Blue.
The Pope has got it and so do you.
Come on everybody we've got quiltin' to do.
Gonna break down these barricades everyone has AIDS,
AIDS, AIDS, AIDS...

Re:Save the melodramatic crap

[will_die]

(statistics tend to prove this out- people like sex, seek it out, and are generally not monogamous)

Which surveys?
If anything surveys tend show that people are primarily mongamous and are happy in a with a relationship with a single person.
Look at something like the http://www.zogby.com/soundbites/ReadClips.dbm?ID=1 1954 from late 2005. The survey was done online so you would expect that it to be a little high on the anything goes side.
Even there you get over 70% of the people in a monogamous relationship, the majority for over 5 years.
While they may seek it out people don't tend to pay, less then 15%. This number is about the same for various other surveys.
If you get thoses types of numbers in an survey where people had to activly seek out the survey the numbers are going to be a lot less if you did a truly random survey of the population.

Re:Save the melodramatic crap

[Fhqwhgadss]

But I think there's a large social issue here.

You hit the nail right on the head. In the United States at least, AIDS is far more of a social problem than a medical problem. The fact that it firt appeared in the gay male community has had an enormous impact on the way that the disease is perceived.

For society that was founded on puitanical grounds, AIDS has been a godsend (pun intended). The evangelicals had a way to immediately lash out against homosexuality as the cause of all of our problems. When the disease migrated to the straight population, we were inundated with the I-got-AIDS-on-my-first-time stories and told to save ourselves for marriage. Fear, whether of AIDS or the lake of fire, is the puritan's greatest weapon.

Then there's the fact that a large portion of our entertainment industry is gay. With the deaths of Rock Hudson and Liberace on thier minds, entertainers became more open and it gradually became more acceptable to homosexuals to "come out." The most significant positive side-effect of AIDS has been the acceptance of homosexuality as at least real, if not acceptable, to American society in general.

The somewhat ironic thing is that without the wanton promiscuity that came about as a backlash against Amirican puritanism, AIDS would not be nearly as widespread as it is today. If it were acceptable to have sex with more than one person on a regular basis, but within a group of mutually respected, trusted, and loved individuals, containment of the disease would be far easier. As it is we live on two extermes: one of excess and one of fear, and the two ideologies feed each other.

AIDS in the US if far more of a social construct than a medical one. There are very few places outside of sub-Saharan Africa that have a greater than 2% infection rate, and even so a great majority of those 2% are in well-defined high-risk groups. Yes, prevention is needed. Yes, research into medical treatment is needed. But can we stop calling it a pandemic already? Sensationalism does not serve the public interest.

Terrific Idea

[scrub76]

The evidence that AIDS drugs can prevent infections comes not only from exposed health care workers, but also monkey studies. If monkeys are given AIDS drugs up to 48 hours before exposure to SIV (the causitive agent of simian AIDS), they fail to become infected. That has been known since the late 90s. There is some data suggesting that the drugs can't always protect against multiple exposures to SIV, but those studies used only one drug at a time (not a cocktail of pills, like you would take if you had HIV).

As an HIV researcher myself, I realize that we are not going to have a highly effective, preventative vaccine for HIV any time in the near future. There are no clear 'winners' in the pipeline right now, and even if a vaccine looked effective right now, it would be years (and millions of new infections) before it clears human testing and it broadly available. Issues like viral resistance to the vaccine, incomplete protection from infection, potential side effects, and a false sense of security would plauge any vaccine that is developed -- and these are many of the same issues confronting the use of drugs as HIV preventatives.

One major hurdle to testing these drugs in populations highly affected by HIV is to convince them that this intervention is not a magic bullet. There will be problems, some of which we probably can't predict. There will be breakthrough infections in people taking the drugs. And the long-term health consequences aren't known. So far, these concerns have led to the abandonment of several trials of PrEP (using tenofovir in HIV-, high-risk populations) around the world. Hopefully the new data (using multiple drugs together works better than tenofovir alone) will encourage vulnerable populations that the potential benefits may outweigh the risks.

Re:Vaccine

[CosmeticLobotamy]

Brilliant! We'll just make vaccines! Why has no one thought of this before? I guess it's just one of those things that seems obvious in hindsight.

This is tough to read over and over again

[Loundry]

As an AIDS heretic, I find articles like these tiresome to read. There have been many, many such articles about "curing AIDS" which have all proven to be sound and fury signifying nothing. I think the reason for this is because AIDS has become something much larger than a disease. It is a way of life for thousands of scientists, a huge cash cow for drug manufacturers, and a political plank for both gay activists and gay-bashing activists.

If you are open to the idea that the orthodoxy about AIDS might not be correct or might not be scientific, then I suggest you read these two pieces of investigative journalism that came out a couple of months ago. They detail in the most succinct way possible how AIDS came about, and that is *VERY* hard to do because of how immensely complex this subject is.

http://www.sparks-of-light.org/HIVGATE%20-%20revie w%20copy.pdf

http://www.sparks-of-light.org/AIDSGATE%20-%20what %20caused%20AIDS%20if%20not%20HIV.pdf

If you think that I'm insane, or that I just want to have a whole lot of unprotected sex, or that I'm a conspiracy theorist, then please just ignore this post. It means that you are not open-minded to criticism of your ideas, and the only thing I want to do is give criticism of the HIV-AIDS hypothesis a fair hearing. I believe that there are HUGE problems with the hypothesis and it has led to many people getting fabulously wealthy off of what has turned out to be misdiagnosis. I am aware that this is a serious charge, and I do not take this subject lightly.

All of that is in effort to say, "Don't mod me down. Don't be a jerk. Don't prevent someone who *wants* to hear what I have to say from hearing it." I hope it works.

Re:This is tough to read over and over again

[geekyMD]

What a bunch of tripe. Michael Moore would be really proud of the first paper. (I didn't read the second one, sorry) I can excuse the writer if 1/2 of the inaccuracies are from an ignorance of the field, but it honestly seems like she's trying to dissuade. Virtually every 3rd paragraph contains and inaccuracy or inappropriate insinuation that is subtle enough to be missed by someone who isn't trained in these fields. The author focuses her arguments by looking at small segments of the literature and history and ignoring the broader sweeps. For example:

The paper's initial assertion is that AIDS was introduced as a polio virus. Simple logical disproof: 1) polio vaccine is given across social/habitual classes. 2) There has not been 1 case of AIDS where the person didn't have one of the following three risk factors: blood transfusion, risky sex*, IV drug use. 3) Not everyone in the US has previous three risk factors. 4) If 2 is true 1 or 3 must be false or at least excruciatingly improbable. 5) 3 is true, therefore 1 must be false. QED. (*risky sex = sexual activity where both partners are not exclusively monogamous to each other at any time during or prior to their relationship)

Several pages deal with the controversy surrounding the initial discovery of the HIV virus. There was also controversy surrounding the discovery of DNA, therefore we shouldn't believe DNA is the 'source code' of life?

She makes light of the microliter aliquots used in the CBC tests but fails to mention that all CBC tests (test which count the types and number of cells in your blood) uses these metrics. We shouldn't trust tests for hundreds of diseases including leukemia, polycythemia, or even iron deficiency based on this implication. (for example, look at the normals on this page: http://www.saintfranciscare.com/11377.cfm)

She also does not respect the validity of the HIV Load test, saying that since it uses PCR (a very common technique in medicine) it cannot be accurate. (no more genetic testing, goodbye cancer diagnosis, goodbye endocrinology) She also asserts that the HIV Load assay will give false-positives and is inaccurate if the procedures are not followed. Yes, it does give false positives, it is a HIGHLY sensitive test, with a low specificity. It is not a screening test, and it cannot be used for one because of its high false positive rate. Additionally, I challenge anyone to find a test in any field that is valid when its procedures are not followed. (magnetism doesn't attract wood, therefore magnetism is false)
http://www.labtestsonline.org/understanding/analyt es/viral_load/test.html

But the coup-de-gras for me was her statistics that showed how low CD4 counts don't correlate to AIDS. (AIDS is, incidentally, practically being defined by low CD4 count)

* "61% of people with CD4 count = 200 in 1997 were AIDS free"
* -response: Yes, CD4=200 is the upper limit at which you see AIDS symptoms, this is expected

* "190,000 Americans in 1993 with CD4 count=200 were AIDS free"
* -response: See above, plus in 1993 the AIDS definition was changing so you see changes in the statistics. Additionally, that number is far less than a quarter of the number of AIDS cases in the US that year. (http://wonder.cdc.gov/wonder/data/aidsPublic.html )

* "No studies have been done to show removal of anti-retrovirals = disease"
* -response: No, but anti-retovirals have been tightly correlated to increased CD4 counts, and their withdrawal to lower CD4 counts. It has also been shown repeatedly (and even in this paper!) that low CD4 count correlates with disease.

The list goes on and on. I just pointed out a few of the most egregious and most easily refuted examples. It just goes to show that if someone really wants to believe someth

Re:Time for the....

[Guppy06]

I don't get it, personally. How many Slashdotters are actually at risk? The only way I could see someone around here getting it is from a blood transfusion.

are you nuts!

[Anonymous Coward]

as an AIDS counsellor, I've worked with many people who are taking these drugs on a daily basis. While they are a brilliant development and have already saved millions of lives, they are EXTREMELY TOXIC; they are totally unsuitable for preventive purposes, apart from being very expensive, they require regular blood tests for specialised medical monitoring (to check your body's responses, get the doses correct, etc), and there are often really grim side effects (such as vomiting, diahoerrea, nausea, fatigue, depression, etc etc); I know many who have chosen to come off the drugs because the quality of their life had got so bad from the side effects that they would rather die with a bit of diginity.

They hammer your immune system; it's like taking poison every day, it's a bit like chemotherapy in ways.. in fact, that's not a bad analogy: why don't we all start on an ongoing course of chemotherapy as a preventive measure against getting cancer?

ps. I'm not an Anonymous Coward, I'm a *Lazy* Anonymous Coward from Ireland

What to expect.

[sammy baby]

Expect immediate, heavy resistance from the ultra-right wing, Christian conservative political forces in the US. Experience has shown that if there's a disease that increases the potential negative consequences of having sex, especially those which disproportionately affect women, they will oppose efforts to provide treatment. (Women in heterosexual relationships carry an increased risk of HIV transmission when compared to men, although they have a decreased risk in homosexual relationships. The reasons I leave as an exercise for the reader.)

Case in point: the human papilloma virus, or HPV. Now here's the thing with HPV: it's sexually transmitted, condoms don't protect against it, and doctors believe that it's responsible for seven out of ten cases of cervical cancer later in life. So, if we could develop a vaccine against it, that would be a huge strike against cancer, right?

Well... sure. But ultra right groups like the Family Research Council oppose such a vaccine, even though pharmaceutical companies have already conducted successful clinical trials. Why? Because they want to scare people into not having sex.

"Giving the HPV vaccine to young women could be potentially harmful," Bridget Maher of the Family Research Council told the British magazine New Scientist, "because they may see it as a license to engage in premarital sex."

If this is the reaction an HPV vaccine (or, for that matter, condoms) gets, how do you think they're going to react to a cure to something which disproportionately affects gay men?

face the facts

[penguin-collective]

what if one of the various "environmental factors" models is right rather than the "single pathogen" model?

That's just not a serious possibility anymore; here are just some basic observations:

• While clinical diagnosis relies on symptoms, HIV infection has been followed in minute detail from initial transmission to death numerous times, in the presence and absence of treatment, in individuals with completely different histories, at the molecular level, at the tissue level, and at the clinical level.
  
• The epidemiology of HIV has been studied extensively: the disease is clearly transmissible and no other factor than an existing HIV infection is associated with transmission.
  
• Drugs specifically targeted at HIV have increased survival rates tremendously, while changes in lifestyle have had limited effect.
  
• The molecular mechanisms of resistance to HIV infection (found in a few percent of the population) are well understood.
  

Single pathogens are sexy for epidemiologists.

Yes, and they are also the rule for infectious diseases. While susceptibility and severity of a disease may vary with environmental factors, for infectious diseases, there is usually a well-defined, clearly characterizable pathogen responsible.

Re:Stay with me

[geekyMD]

First off, I did not mean to make it personal. Just my own views. I can see how what I said could be insulting, and I really did not mean that. Science moves forward by challenging the establishment. 200 years ago if you told someone that the heard functions to pump blood they would have laughed at you. 50 years ago universal precautions were virtually unknown. Sometimes the 'crackpots' get it right, so its neccicary to regorously examine their claims. I'm sorry you've been insulted for your views, I hope not to do that, but only to engage in debate. I really wish we could sit down over coffee with a couple of text books and journals and really talk about this stuff. Lets move on...

The reason I didn't tackle some of the other issues (and not necciarly the primary 4 you referred to) was that I don't have it. It would require a paper of triple the lenght of the original to compose a fully cited and complete rebuttle. Many of the 'harder issues' I referred to require background that is not easy to impart quickly and briefly. For example, I have no clue how the math works behind the Riemann Zeta equation, and I doubt anything less than months if not years of intense study would bring me up to speed. http://science.slashdot.org/article.pl?sid=06/03/2 7/1315212 The issues at hand are definately not that erudite, but I hope you get my meaning. My point for some my contentions was that the author of the article was making fun of simple ideas like "lightbulbs make light", and so she earned some easy crackpot points for belittling fundamental ideas. (overt anti-establishment thought process to the point of scientific disregard)

To answer your 4 questions:
1) Yes, I will admit that the mechanism has not been elucidated. However, the word idiopathic peppers medical literature, it is not uncommon to not know the exact mechanism, but to know generally whats happening. For example, digoxin (aka. digitalis) has been around since 1756, but the exact mechanism of how it effects cardiomyocytes is still under investigation. There are several theories, some very good, but none have been proven conclusively. A lot of pharmacology is that way. But I digress. What has been shown is that if you take blood from someone with aids, and inject into another person, you get aids in that person too. Furthermore, if you isolate HIV from the blood of an infected person you can induce CD4 cell destruction and AIDS like symptoms in model organisms. Lets hope someone has not tried this on humans. Of course, this explaination will not hold water for you if you do not believe HIV can be isolated, so lets move on to #2.

2) The initial research was flawed, granted. However, their research has been followed by others who have not been as fraudulent. I offer this instead:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=pubmed&dopt=Abstract&list_uids=1656345 8&query_hl=2&itool=pubmed_docsum

Plus, there are more ways than antibodies to detect HIV. HIV is a dsDNA virus with many unique proteins in its repitoire. Yes, there are other retroviruses out there, and some have embedded themselves in our DNA. However, they do not have the same genetic sequence of HIV. HIV like any unique organism has a unique genetic code. It has been sequenced, and is in fact regularly sequenced to determine which drugs the patients are treated with. The correlation is emperical - different HIV sequences have been shown to correlate 100% with resistance or succeptability to certain drugs. There are many sequences due to the innacuracies of reverse transcriptase, and not all of these changes result in a functional modification.

You cannot isolate the HIV DNA sequence from someone not infect