Daily pills take a lot of time investment; monthly shots are better; but once every 6 months is awesome! Especially in circumstances where it might be difficult to guarantee a daily pill or even a monthly shot.
Apretude has lower efficacy than Descovy or Truvada, but once you factor in human error in taking a daily pill regimen, it is more even. Human error is a significant factor since the current treatment protocols say if you’re not sure whether or not to take it, it is safer to skip than to accidentally double the dose.
AIDS kills more people than malaria, and preventing malaria has long been viewed as one of the lowest hanging fruits in public health.
Hoping for eradication is too much with the limited immunity duration, but if we can mass produce a vaccine - even if it has to be administered twice a year - this could save millions of lives over the course of a decade.
That is a matter of opinion. How much time do you think it takes to swallow a pill?
Here's another example of a pill that needs to be taken every day, at approximately the same time of day: https://www.plannedparenthood.org/learn/birth-control/birth-...
From this article on that pill,
> But people aren’t perfect and it’s easy to forget or miss pills — so in reality the pill is about 93% effective. That means about 7 out of 100 pill users get pregnant each year.
You mess up and you have HIV for life. It's better to have something that provides more stable protection :)
Having a shot like this be widely available will be an important stepping stone for eradicating HIV.
Of course it's easier to get a shot than to take individual pills, I think people would universally agree on that.
Also with prep, since you have to continue dosing 2 days after last activity you get awkward situations where you left it at home or get distracted by life events.
I think this is more common because most people do event based dosing rather than continuous (which would form a habit of taking it every day).
So not as well? Is there a biological reason for this?
Also, is it typical to do such studies on single genders rather than on a mix of humans?
- Women and girls make up the majority of HIV cases, especially in the developing world
- If you're estimating the effect in both men and women, you're reducing your power to detect an effect in either group. If you have a limited budget, it's going to be hard to recruit, etc., you may well be better off powering your study for the group you think is going to be the most impactful, then going back. We saw this with the HPV vaccine - getting it going in the highest impact groups, and then going back later
- Preventing HIV in women also prevents maternal to child transmission
- "Men with HIV" are actually two different groups - men who have sex exclusively with women, and men who have sex with men. You then also need to power your study for both sub-groups.
https://ourworldindata.org/hiv-aids
The only place this isn't true is sub-Saharan Africa. As there's no biological explanation for that discrepancy it's been hypothesized that it's because in Africa a lot of reported HIV cases are fraudulent, due to the large amount of AIDS/women specific foreign aid money and weak auditing standards.
Receptive vaginal sex: 0.08% (1 transmission per 1,250 exposures)
Insertive vaginal sex: 0.04% (1 transmission per 2,500 exposures)
Receptive anal sex: 1.4% (1 transmission per 71 exposures.)
Insertive anal sex: 0.11% (1 transmission per 909 exposures)
[1] https://stanfordhealthcare.org/medical-conditions/sexual-and...
https://www.cdc.gov/hiv-data/nhss/estimated-hiv-incidence-an...
It's amazing that a small-molecule drug can be that effective for six months. It's not a vaccine. It doesn't stimulate the immune system. Completely different mechanism. It's not a slow-release implanted thing, either.
Because of this, it seems very likely that if any patient being treated with this drug ever discontinued it, they could develop HIV quickly from cells that were already infected in their body that had been suppressed from producing virus particles but were no longer suppressed.
I was not able to find, in a little searching, any study at all on whether cells infected during treatment survive or are somehow cleared by the immune system or undergo apoptosis. Without this information it seems highly irresponsible to claim that this is a method of preventing HIV infection.
Lenacapavir interferes "with multiple essential steps of the viral lifecycle, including capsid-mediated nuclear uptake of HIV-1 proviral DNA (by blocking nuclear import proteins binding to capsid), virus assembly and release (by interfering with Gag/Gag-Pol functioning, reducing production of capsid protein subunits), and capsid core formation (by disrupting the rate of capsid subunit association, leading to malformed capsids)" [1].
For comparison, tenofovir diphosphate (from Descovy) "inhibits the activity of HIV reverse transcriptase and causes DNA chain termination after getting incorporated into the viral DNA" [2].
Descovy thus works at stage 3 (reverse transcription); Lenacapavir works at stages 3 (integration), 6 (assembly) and 7 (budding) [3].
> it seems very likely that if any patient being treated with this drug ever discontinued it, they could develop HIV quickly from cells that were already infected in their body
HIV-uninhibted T cells should be fine clearing these out. IT would be more surprising to see the cells stick around after having been infected.
[1] https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e56...
[2] https://www.clinicaltrialsarena.com/projects/descovy-emtrici...
[3] https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-li...
You did not provide any reference showing that cells that are actually infected but inhibited from producing virus through late stage assembly inhibitors are effectively eliminated by the immune system.
Cabotegravir is an integrase strand transfer inhibitor. This means it blocks the HIV's enzyme integrase, thereby preventing its genome from being integrated into the human cells' DNA.
Emtricitabine is an analogue of cytidine. The drug works by inhibiting reverse transcriptase, the enzyme that copies HIV RNA into new viral DNA.
Both of these drugs actually prevent infection.
People with HIV and on ARVs don't develop AIDS either, and any study that watched people contract HIV but didn't provide their participants with ARVs would be both unethical and pointless.
And per the article,
> Drugmaker Gilead said it will allow cheap, generic versions to be sold in 120 poor countries with high HIV rates — mostly in Africa, Southeast Asia and the Caribbean.
So, the places that need it most will be able to get it for cheap. This is about as positive of a result as can be with how the modern world is currently laid out.
The people that need it the most in the countries that need it the most will likely be able to get it.
It's still about a dollar a day, which is a lot of money for the most needy.
Now? You don't keep up on your immunisations? Ever seen an old person's medicine cabinet?
