[VeryAnonymous]

The thing that worries me about antiretroviral drugs is that they mess with mechanisms that are innate to the reproduction of cells.

Their effects can, e.g., be clearly seen in changes to the bone marrow, which IIRC has some of the fastest-reproducing cells in the human body.

We don't have long-term data yet on what this does to users of this drug.

My wife has to take such drugs as she has HIV, and I wouldn't be surprised if it ended up shaving a few years off her life expectancy. She's fine now, but who can predict the cumulative effects? Of course, since without the drugs her life expectancy would be drastically lower, she obviously takes them, and they are a godsend.

But I'm kinda waiting for the other shoe to drop.

What I'm saying is: it's great that we have this option, and it should be used where it makes sense. However don't think that this medication frees you from worry in the same way vaccinations typically do. The tradeoff is much different.

[matthewmacleod]

It's true that there are definitely some side-effects and we'll need to wait and see what the long-term consequences are. The good news is that they at least appear to be well-tolerated drugs, and newer drugs show fewer adverse effects - minor bone-density reduction and renal function impact are the main adverse effects of Tenofovir + Emtricitabine, with no obvious effect on bone marrow for example.

But it's quite a tricky decision to make. Vaccines aren't without risk either, though adverse reactions are also rare. Certainly from a cost perspective, PReP with high efficiency makes a lot of sense – lifetime treatment and monitoring of an HIV+ patient can be markedly more expensive than a relatively cheap preventative medication, especially in high-risk groups.

I have been beating around the idea of taking PReP for a while, what with being part of a higher-risk group in an area with relatively high HIV prevalence. It's definitely a harder commitment to make than vaccination is, but I hope that we can improve our knowledge and understanding of the risks as the trials currently underway progress.