I had to do some digging to find any source on the effectiveness on preventing transmission (the recent FDA approval is for post infection treatment).
The study I found is [0]. In a double blinded study of 4,600 participants, half were given the cabotegravir injection, and half were given the daily oral treatment. The study notes a "high level of adherence to oral therapy"; however, the actual numbers on adherence are:
> Adherence to oral FTC/TDF was high, based on a random subset sampling that detected tenofovir (> 0.31 ng/ml) in 87% of all samples tested.
I'm not qualified to say if this actually indicates 87% adherence, or if a fully compliant patient may get a negative result on that test.
The result of this study was that 50 particpants got HIV, of which 12 were on the injectable and 38 were on the oral.
By my calculation, this gives a relative effectiveness of (38-13)/38 = 68.4%, although the paper reports 69%.
[0] https://viivhealthcare.com/en-us/us-news/us-articles/2020/gl...
Americans aren't going to develop an efficient approach that is not highly encumbered because the FDA stacks the deck against approval of efficient solutions in favor of whatever makes the most total profit. So you'll see that sort of thing approved overseas and we'll get it (or not) in a decade or maybe never.
I see nothing wrong with sacrificing a few men, who consent and sign up and know the risk, for the far larger majority.
If better drugs can be developed that would serve millions by sacrificing a hundred consenting subjects that know they run this risk, that seems like an overall benefit to me.
It seems rather irrational to not be willing to do this. — It is fine if men die, so long as their blood not be on my hands directly, but only indirectly.
It seems that whenever a perfect placebo be permissible, that is what is being used rather than the current standard of care.
Soldiers can be sent to their death for oil and other resources that benefit the larger majority? but this is “yikes”?, not a phrase I find to occur in conjunction with rational decisions often.
It is. Control groups are no-treatment if no approved treatment exists, or current standard of care if there's an approved treatment. That's standard practice.
> It seems that whenever a perfect placebo be permissible, that is what is being used rather than the current standard of care.
If by "perfect placebo," you mean "no treatment," that's not correct, and is considered unethical.
I've read plenty of pharmaceutical trials where the control was a plain placebo, not the current standard of care, when it not involve a life threatening illness.
https://clinicaltrials.gov/ct2/show/NCT00061802
Clearly this antipsychotics trial does not evaluate the drug 's effectiveness against the current standard of care's, but against a placebo's.
> If by "perfect placebo," you mean "no treatment," that's not correct, and is considered unethical.
I mean giving them a drug that lacks an active ingredient but is otherwise not to the lay eye discriminatable from an effective drug.
And that is very much what is done in the case of the antipsychotics medicine I showed. So it's only unethical when human lives be at stake, apparently.
However, from reading the article, I do think there’s a convenience factor at play related to the struggles of taking pills daily.
Note though, the article mentioned a trial of _women_ where truvada and one-shot prevention effectiveness were compared and the one-shot was deemed 89% more effective.
A quick search explains _why_ this might be the case for women. Basically, it takes more truvada to get rid of the disease in vaginal and cervical tissue than it takes for rectal tissue.
Source: https://www.uspharmacist.com/article/why-do-women-need-highe...
Also, doctors have been recommending a different drug, Descovy, for prep instead of Truvada. This isn’t due to effectiveness but side effects I believe. I guess if one experienced side effects though, they would be less likely to continue taking the medicine.
https://www.poz.com/drug/cabenuva seems to suggest it is intramuscular (administered in the buttocks, which is not hard to do by oneself) but requires a healthcare provider. Not sure why, there might be storage requirements and such.
Even if you self-inject and find it easy, I’m sure you’re not saying it’s easier and less of a hassle than taking a pill lmao.
Injectables seemed scary right until the moment when I started taking them, after which they became a normal part of my life.
EDIT: Not sure why this is getting downvoted. Since when on HN is it acceptable for someone to say “I think this way so it must be a fact” without providing an explanation? Even when it comes to subjectivity, there’s an expectation that people share why they believe in their opinion, right?
I swear I dislike this site and the people who use it more and more every week.
All you said was “it’s easier” in your original point. You obviously felt the need to clarify yourself in your most recent comment. So clearly your first comment was lacking information. There was no reason to downvote me just because you felt my original comment made you look stupid.
FWIW, even though “easy” is subjective, there’s still a consensus to be considered. For example, finding piercing your skin with a needle to be an asthetically-pleasing act does not fit that consensus...
Something that _does_ fit the consensus is that taking a pill every day is a hassle.
Stop being facetious just to prove a point.
This pandemic has been hard on all of us. Take care.
I looked at your comment history and you say “in fact” without supporting your opinions _often_ to the point that I laughed.
Also, you edited your original comment which probably led to the downvotes.
I’m assuming you must also correlate the pandemic with your immaturity then.
Also, if you click damnyou@‘s comment history, you’ll clearly see that he loves using the phrase “in fact” without supporting his assumptions. I didn’t deserve to be downvoted.
I edited my comment within a couple minutes of posting it. Sorry about the confusion.
And sorry if you actually do prefer those gender terms. But honestly, it sounds like you’re just making shit up. I’m assuming you’re just a young white kid. I’ve met many of you in the tech industry who act like that. “Oh, I said something stupid and fucked up, let me pretend to be ‘woke’”. People like you exhaust me.
Also, just because something appears convenient doesn’t mean that it actually is.
Have you looked up how many women use one of those invasive contraceptive implants?
Technically, a woman only has to get a new implant once every 4 years+. But have you not read the horror stories about the implants becoming dislodged and causing internal bleeding and severe damage?
Also, people on PrEP already need to do regular bloodwork, so needles and appointments are already involved every few months. Doing an appointment every 2 months instead of every 3 and not needing to take a daily pill as well is a huge win in level of effort.
Your first sentence makes no sense. You say that I’m implying that pills are more popular yet you confirm that indeed they are.
Unless, you’re saying that I was implying that they’re _heavily_ more popular, which is also not what I implied.
You’re completely missing the point. I’m gay and on prep myself for several years.
The grandfather post mentioned that 2 million people are doing an injection as if that implies that many people prefer that over pills.
I could write more and explain more but I’m tired of talking to so many morons for today.
I think this is a wonderful thing and that we should spread the word when these new treatments are available so that more people know they have options if they like the sound of occasional injections but don't like daily pills or vice versa.
No, effectively used Truvada works very well.
> Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering?
Probably almost certainly yes or it's just a small improvement at the margin.
They present themselves as helping the patient navigate a complex drug, but in practice this just meant they had a bunch of questions to tick off each time you talked to them. Their outreach and phone tree were both pretty bad, clearly designed for high operator utilization and not customer service.
"...abotegravir – a component of Cabenuva – was 89% more effective in preventing infection among women than Truvada"
That 89% when was compared to Truvada.
Do healthcare workers actively take Prep or is it administered within the 72 hour period after exposure?
Prep from what I understand can be hard on the body's organs and you will need to do a kidney function test every few months when on it
PEP =/= PREP. PEP is after the fact treatment, there's more than just Truvada in that protocol.
PEP is typically much harder on the body than PREP.
Most every gay man I know takes PREP with few or no side effects.
What is this based on? Was I misinformed about Truvada's effectiveness? Is this a decrease in an already very low chance of transmission? Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering?
It's currently common in the gay community for sexually active, healthy people to take Truvada proactively to protect against HIV because it's understood to be even more effective than condoms. If there is a better option or if the current option is not as effective as widely believed then standard of care should change.