A Bit More Detail

Assorted Personal Notations, Essays, and Other Jottings

Posts Tagged ‘truvada

[BLOG] Some Tuesday links

  • Architectuul notes the recent death of I.M. Pei.
  • Bad Astronomer Phil Plait notes what, exactly, rubble-pile asteroids are.
  • The Broadside Blog’s Caitlin Kelly writes about definitions of home.
  • Centauri Dreams considers white dwarf planets.
  • The Crux notes how ultra-processed foods are liked closely to weight gain.
  • D-Brief observes that a thin layer of insulating ice might be saving the subsurface oceans of Pluto from freezing out.
  • Bruce Dorminey notes the critical role played by Apollo 10 in getting NASA ready for the Moon landings.
  • The Dragon’s Tales notes the American government’s expectation that China will seek to set up its own global network of military bases.
  • Andrew LePage at Drew Ex Machina reports on the Soviet Union’s Venera 5 and 6 missions to Venus.
  • Far Outliers looks at the visit of U.S. Grant to Japan and China.
  • Gizmodo notes a recent analysis of Neanderthal teeth suggesting that they split with Homo sapiens at a date substantially earlier than commonly believed.
  • io9 notes the sheer scale of the Jonathan Hickman reboots for the X-Men comics of Marvel.
  • Joe. My. God. shares the argument of Ted Cruz that people should stop making fun of his “space pirate” suggestion.I am inclined to think Cruz more right than not, actually.
  • JSTOR Daily notes the wave of anti-black violence that hit the United States in 1919, often driven by returned veterans.
  • Language Hat shares a recognizable complaint, written in ancient Akkadian, of bad customers.
  • Language Log shares a report of a village in Brittany seeking people to decipher a mysterious etching.
  • This Scott Lemieux report at Lawyers, Guns and Money about how British conservatives received Ben Shapiro is a must-read summary.
  • Benjamin Markovits at the LRB Blog shares the reasons why he left his immigrant-heavy basketball team in Germany.
  • Marginal Revolution looks at one effort in Brazil to separate people from their street gangs.
  • The NYR Daily looks at how ISIS, deprived of its proto-state, has managed to thrive as a decentralized network.
  • Personal Reflections’ Jim Belshaw tells of his experiences and perceptions of his native region of New England, in southeastern Australia.
  • The Planetary Society Blog notes how the Chang’e 4 rover may have found lunar mantle on the surface of the Moon.
  • The Power and the Money’s Noel Maurer notes that while Argentine president Mauricio Macri is polling badly, his opponents are not polling well.
  • Roads and Kingdoms shares a list of things to do in see in the Peru capital of Lima.
  • The Signal examines how the Library of Congress engages in photodocumentation.
  • Van Waffle at the Speed River Journal explains how he is helping native insects by planting native plants in his garden.
  • Starts With A Bang’s Ethan Siegel notes how scientific illiteracy should never be seen as cool.
  • Towleroad notes the questions of Alexandria Ocasio-Cortez as to why Truvada costs so much in the United States.
  • Window on Eurasia notes how family structures in the North Caucasus are at once modernizing and becoming more conservative.
  • Yorkshire Ranter Alex Harrowell notes how the distribution of US carriers and their fleets at present does not support the idea of a planned impending war with Iran.
  • Arnold Zwicky examines the tent caterpillar of California.

[PHOTO] “Take Part in a Sexual Health Revolution”

My eye was caught when I saw, on a subway train somewhere in Brooklyn, this ad advertising PrEP.

"Take Part in a Sexual Health Revolution" #newyorkcity #newyork #subway #ad #prep #hiv #hivaids #hivawareness #latergram #preexposureprophylaxis

The preventative use of the drug Truvada to prevent HIV infection in HIV-negative people has come a long way. I first noted PrEP directly in a November 2014 post, that one reflecting on how far the idea of using anti-HIV medications to prevent HIV infection had come since I first heard of the idea in a 2005 article talking about how crystal meth users would take Truvada component tenofovir before heading off on drug-fueled orgies.

PrEP has gone far beyond those early days. It is now mainstream, approved of by the CDC and supported by the New York City Department of Health. Local health organizations like the Gay Men’s Health Crisis and the Callen-Lorde Community Health Centre can apparently set people up with Truvada at reasonable cost and in reasonable amounts of time. It’s even available in Canada, Truvada being covered since September under Ontario’s provincial drug plan. I’m considering the mechanics of getting on it myself.

And yet, here in Ontario and in Toronto, home to a MSM community surely as intrisically at risk of HIV infection as New York City’s, PrEP does not have nearly the same mainstream presence as in New York City. The biggest article I’ve seen on it on the non-LGBTQ media was Josh Dehaas’ oddly dismissive article. Straight people I’ve talked to about the drug here in Canada have been routinely amazed by the fact of the existence of PrEP. Shouldn’t Toronto, at least, try to change this?

Written by Randy McDonald

February 3, 2018 at 2:45 pm

[LINK] On PrEP in Canada

Daily Xtra and The Homo Culture were among the first news sources in my Facebook timeline to announce the approval of Truvada for PrEP. Toronto’s Metro was among the many mainstream news sources to carry the news.

A drug that can stop the transmission of HIV is getting within reach of Torontonians who can’t afford its steep price.

Health Canada approved the use of Truvada on Monday as a prevention tool commonly called PrEP, giving people who can’t afford its $830 a month cost hope that they might be able to take it someday soon.

Until now, people using the drug for prevention have mostly been part of a “lucky minority” with “good, private drug insurance coverage,” said Dr. Darrell Tan, an infectious diseases specialist at St. Michael’s Hospital.

“That leaves people with the option of going without or purchasing it out of pocket —which is exorbitantly, prohibitively expensive for the vast majority of individuals,” he said.

Truvada was approved in Canada a decade ago as a management tool for people who already have HIV. Monday’s decision takes that approval further, extending it to include use by HIV negative people who are looking to stay negative.

At roughly the same time, there was also a news report noting the first verifiable report of PrEP failing to protect a user. Aidsmap described how a user in Toronto had the bad luck to get infected with a Truvada-resistant virus in a sexual partner whose HIV was suppressed.

During this time he came in for his regular HIV test and this showed he had acute HIV infection, with a negative test for HIV antibodies but a positive test for the HIV p24 antigen, which shows up sooner. His HIV viral load three days later was 28,000 copies/ml – rather low for acute HIV infection and suggestive that either his PrEP had ‘blunted’ viral replication without stopping infection, or that the highly drug-resistant virus was replicating weakly.

[. . .]

The resistance test showed that the patient had HIV that had no significant resistance to the protease inhibitor class of antiretrovirals. He had one resistance mutation to the first generation NNRTI drug nevirapine, and complete resistance to emtricitabine. He also had extensive resistance to the first-generation NRTI drugs like zidovudine (AZT) and stavudine (d4T), and these mutations also confer some resistance to tenofovir. However he did not have the so-called K65R mutation that confers high-level resistance to tenofovir, and it was estimated that the resistance pattern he did have only confers 1.3-fold resistance to tenofovir, meaning that drug levels 30% higher than those needed for non-resistant virus should have been enough to prevent infection – and he had much higher drug levels than this in the tests. Resistance, however is a complex process and some combinations of mutations can catalyse higher levels of resistance than they would produce alone.

Not relevant to the apparent PrEP failure, but to the spread of drug resistance, was the fact that this patient also had two resistance mutations to the integrase inhibitor drugs and complete resistance to the drug elvitegravir.

Transmission of HIV with integrase inhibitor resistance is very rare, and especially resistance to drugs other than raltegravir, the first integrase inhibitor. The pattern of resistance observed is compatible with the unnamed person who passed on the virus being on a failing regimen of Stribild (the two-class, four-drug combination pill of tenofovir, emtricitabine, elvitegravir and cobicistat). Given that four out of the five first-line HIV drug regimens recommended by the US Department of Health and Human Services are integrase inhibitor-based, and that this drug class is being investigated for use as PrEP, it would be of concern if more integrase inhibitor-resistant virus started to circulate.

The patient himself was put on a potent three-class regimen of dolutegravir, rilpivirine and boosted darunavir and became virally undetectable only three weeks after starting it.

This sort of failure is the sort of failure to be expected in an instance of PrEP failing. It does not undermine the utility of this technique.

Written by Randy McDonald

March 6, 2016 at 9:05 pm

[BRIEF NOTE] On the effectiveness of PReP in preventing HIV infection

I first heard of pre-exposure prophylaxis drug treatments for HIV in December of 2005, when I came across a widely-syndicated article talking about the off-label use of tenofovir by sexually active gay men to ward off infection.

“Taking a T.” That’s what HIV-negative gay men call the growing practice of downing the AIDS drug tenofovir and, with fingers crossed, hoping it protects them from the virus during unprotected sex.

It’s being sold in packets along with Viagra and Ecstasy in gay dance clubs — and even prescribed by physicians, say doctors and AIDS prevention experts. The trend has alarmed public health officials. There is no proof that tenofovir protects against HIV transmission, they say. People who practice unsafe sex while taking the drug could still become infected or suffer side effects from it.

Recreational use of AIDS drugs also might increase overall resistance to the medications, HIV experts say. “This is a very worrisome development,” said Dr. David Hardy, an HIV doctor at Cedars-Sinai Medical Center in Los Angeles. He said the drug could lead to an even further erosion of condom use, which studies show has been falling among high-risk populations.

A survey released in July by the U.S. Centers for Disease Control and Prevention, conducted at gay pride events in four cities, found that 7% of uninfected men had taken an AIDS medication before engaging in risky behavior and that about a fifth had heard of someone who had.

[. . .]

“If we find out this works, even in some people, we would never recommend people stop using condoms or reduce their number of sexual partners,” said Jeff Klausner, STD prevention director for the San Francisco Department of Public Health. Nonetheless, there is some research that suggests taking the drug prophylactically can reduce the risk of transmission. Based on promising earlier research, the CDC is funding two clinical trials, begun last year in Atlanta and San Francisco, on whether tenofovir, a staple of the current HIV drug regimen, may act as a shield to infection — much like how a birth control pill can help prevent pregnancy. Each trial is giving 200 high-risk men a daily dose of tenofovir and monitoring them for two years.

The idea struck me, and my commenters, as somewhat ludicrous. Why abandon condoms–a technology that has been proven to be very effective in preventing HIV infection–in favour of a drug that might inhibit HIV infection? (That the article described how some gay users combined their tenofovir usage with ecstasy and other party drugs didn’t make the idea sound much brighter.)

Even so, from these apparently unpromising beginnings tenofovir has lived up to its promise. When combined with emtricitabine as Truvada, the result is a drug that when taken consistently, does a superb job of preventing the sexual transmission of HIV between couples, whether same-sex or opposite sex. Pre-exposure prophylaxis for HIV works. Combined with treatments for HIV that reduce viral load to undetectable levels and prevent further transmission of the virus, it’s starting to look very much as if the HIV pandemic among gay/bisexual men is eminently controllable through drugs. As Josh Barro notes in The New York Times, only a few groups like the AIDS Health Foundation of Los Angeles criticize PReP, arguing that it might lead people to abandon condom usage altogether and paradoxically worsen affairs.

A.H.F. warns against widespread PrEP use on two grounds: In clinical trials, many subjects did not take Truvada nearly as often as prescribed, leaving themselves vulnerable to infection; and even though C.D.C. guidelines call for PrEP patients to use condoms, widespread reliance on the drug could discourage condom use, leading to an increase in H.I.V. and other sexually transmitted infections. In the ads running this week, the foundation warns that “the C.D.C.’s ill-advised strategy of mass treatment with Truvada poses a significant risk to the condom culture, which while it has eroded, has still prevailed among gay men for three decades.”

These sorts of concerns are frequently voiced by prominent gay men; last week, the actor Zachary Quinto wrote for The Huffington Post that he has “heard too many stories of young people taking PrEP as an insurance policy against their tendency toward unprotected non-monogamous sex.” But the consensus among public health experts is the opposite: PrEP’s effectiveness in preventing transmission outweighs the risk that people won’t take their pills, or will stop using condoms.

“I find the adherence is much better in real life, especially for PrEP, than in studies,” said Dr. Ray Martins, the medical director at the Whitman-Walker clinic in Washington, D.C., where approximately 170 patients are on PrEP. He said no PrEP patients at Whitman-Walker had contracted H.I.V. since the clinic started prescribing it two years ago. The iPrEx study, which led to PrEP’s approval by the F.D.A. in 2012, was a global one, and adherence was much higher in the United States than overall, especially in San Francisco, where 90 percent of tests of participants’ blood found detectable levels of Truvada eight weeks after it was prescribed.

As for driving people away from condoms, the iPrEx researchers have found that giving people Truvada has not led to riskier behaviors. That’s surprising, but it’s explained in part by the fact that baseline condom use among gay men is already often poor, PrEP or no PrEP.

Evan J. Peterson’s essay in The Stranger, “The Case for PrEP, or How I Learned to Stop Worrying and Love HIV-Positive Guys”, draws from his personal experience and that of his peers to suggest that PReP simply provides extra safety. I could get behind that.

The only problem? Cost. Here in Canada, Québec is the only province to have PReP guidelines for Truvada; Québec also has a drug plan that soaks up most of the enormous costs associated with the PReP regimen. I do not have a thousand or so extra dollars a month here in Ontario to pay for this prescription myself, and I suspect that most other Ontarians would be in something like my current position. Until something happens–the cost comes down, perhaps, or some sort of government drug plan gets introduced–Truvada for PReP will be something I just won’t be able to access.

I could, if I wanted, imagine a grim sort of scenario where the sexual marketplace shifted in uncomfortable directions as condom usage dropped in response to PReP while PReP itself remained inaccessible to many or most people involved. I’d prefer not to imagine this: I’d like to think modern medicine can save us all, properly incentivized. I suppose we’ll have to wait and see what happens next.

(UPDATE at 11:13 PM: Crossposted to Medium. Let’s see how this works.)

Written by Randy McDonald

November 18, 2014 at 4:03 am

[BLOG] Some Saturday links

  • blogTO shares photos of Scarborough’s motel-heavy Kingston Road.
  • Centauri Dreams features an essay by one Nick Nielsen putting forth a typology of theoretical starships.
  • The Dragon’s Gaze links to one paper analyzing the albedos of hot superearths and to another paper that measured the diameter of superearth Kepler 93b to within 120 kilometers.
  • The Dragon’s Tales links to one paper noting that genetic evidence seems to suggest multiple waves of migrants from Africa and another noting that the mission planners for the New Horizons Pluto probe are looking very late for a Kuiper belt object for their probe to study.
  • Eastern Approaches follows the Ukrainian elections.
  • Marginal Revolution’s Tyler Cowen suggests that the BJP may have the credibility necessary to strike a deal with Pakistan.
  • Progressive Download’s John Farrell notes concern for egg donors as cloning technologies which make use of human ova advance.
  • The Russian Demographics blog notes that the annexation of Crimea by Russia, combined with the secessions of Donetsk and Luhansk, would see the Ukrainian population shrink.
  • Towleroad links to an essay at Out by a man talking about his choice to make use of Truvada to prevent HIV infection.
  • The Volokh Conspiracy notes a sad legal dispute between the parents of a deceased man over the division of his ashes.
  • Window on Eurasia suggests that eastern Ukrainian separatists are trying to encourage separatism from the top down, and notes Russian tensions with the Crimean Tatar leadership.
  • Yorkshire Ranter Alex Harrowell notes the ideological and generational divides within UKIP.

[BLOG] Some Wednesday links

  • The Dragon’s Tales links to news of remarkably thorough reconstruction of Neanderthal and Denisovan genomes.
  • Eastern Approaches visits eastern Ukraine’s Donbas region.
  • Geocurrents’ Martin Lewis notes that Pakistan still apparently lays claim to the former Muslim-run princely state of Junagadh in Gujarat.
  • Joe. My. God. and Towleroad both note a proposed bill before the Russian parliament that would require the fingerprinting of all HIV-positive people in a national database.
  • The Power and the Money’s Noel Maurer notes a continuing crisis in the availability of rental spaces in the American housing market, linking it to low-density zoning.
  • Torontoist notes the sad loss of a pet pigeon on Queen Street West.
  • Towleroad notes continuing controversy over the use of the HIV drug Truvada as a prophylactic against infection.
  • The Volokh Conspiracy visits controveries over affirmative action in the United States where different minorities (here, Asian-Americans) have different claims.
  • Window on Eurasia visits the increasingly problematic lot of Crimean Tatars in their Russian-occupied homeland, notes that traditionally pro-Russian Belarus is newly wary of its eastern partner, and quotes from a journalist who predicts catastrophe from a Russian pursuit of empire.