A Daily Dose of Truvada?

This week the CDC recommended that all Americans at risk of HIV take a daily dose of pre-exposure prophylaxis, or PREP.
Readers asked WELL about Truvada, which is the only drug that’s FDA approved for PREP right now. The first question was: Is it necessary to take the pill every day as it is with birth control pills?
The answer is yes, you cannot stop and start. Not if you’re still having unprotected sex. You can miss a pill occasionally but you’re playing Russian Roulette when you do. An analysis of the IPREP studies showed that men who took their pills seven days a week were 99% protected against infection. Those who only took it two days a week were 76% protected against infection but 76% protected is a 24% not protected so it gets more dangerous as with women who don’t take birth controls every day, you have risk of getting pregnant, you have the risk of getting infected.
A lot of readers asked about cost. Are there cheaper alternative? Why does it have to cost $13,000? And the answer is the pharmaceutical industry has U.S. Congress in an absolute headlock, alright, and the way we do patented medicine in this country. Whoever owns the patent gets to set the price of the medicine. Right now that’s Gilead Sciences…gets to set the price of Truvada at $13,000 a year. Yes, the drug is made more cheaply in India, for example, for less than 300 dollars a year. Um, yes those are legitimate, safe drugs; they’re approved by the WHO. Can you get them in the United States? No, it’s not legal to import them. You can’t buy them. Can you go to Canada or Mexico to get them? Yes but the pharmaceutical industry doesn’t like it when you do that and they’re trying to do what they can to keep people from going over the boarders in order to get drugs, so…in that aspect you’re on your own.
Readers asked about side-effects and the possibility of developing resistant strains of HIV. Alright, there’s a long list of side-effects that you find on any boxes of any drugs and you can look them all up on truvada.com or one of the websites of the drug. It’s considered a relatively safe, low side-effect drug.All drugs have side-effects. There are some severe side-effects, like kidney and liver damage but they’re very rare. There are some common side-effects like headache and nausea but those usually go away and those are side-effects true with almost any drug.
On the resistance question: There isn’t much, ah, evidence that Truvada causes resistance - which is not true of some other HIV drugs like Nevirapine in Africa. They do cause resistance, Truvada seems not to in the studies so far. The truth is nobody knows about the long-term side-effects for Truvada because nobody’s taken it for 20 years yet since it was only approved in 2004. Some of that stuff will turn up as, you know, as more people get on the drug and stay on the drug for a long time.

Source: New York Times

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