[t-writescode]

This is incredibly exciting! The main method available for PrEP, in the United States, at least, is a daily pill. I think (I don't know) there is a monthly shot, too.

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.

[bobthepanda]

There is a generic daily pill (Truvada), a more expensive one (Descovy) and an every two months shot (Apretude.)

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.

[cosmotic]

The data I've seen shows apretude is more effective, not less

[cosmotic]

First party, but I assume there's a lot more rigor and regulation on this than normal first party claims: https://apretude.com/about-apretude/clinical-trials

[m3kw9]

Seen these on commercial, I wish they stop with commercial for meds. Depressing asf, keep reminding me of my mortality while I’m trying to relax and enjoy a moment

[UltraSane]

Do you mean you don't want to be reminded of the risk of STDs when about to engage is sex?

[m3kw9]

I was talking about med ads in general, and yes I don’t need to be reminded humans can get stds from unprotected sex, nor I think that is a place for it

[IshKebab]

Definitely one of the weird things I noticed in America. Most countries do not have medical adverts, for obvious reasons.

[jcul]

Yeah was going to comment the same. Always really strange to see so many adverts for medication when I visit the US.

[quitit]

The problem is the cost, in Europe and the USA the treatment is over $40,000 USD per year, which isn't realistic for regular people.

[4fterd4rk]

Every gay person I know, myself included, is on prep. From the VP at a Fortune 500 on down to a coffeeshop barista. Cost is not an issue, at least not in the United States.

[quitit]

I believe you might be referring to tablet-based PrEP, that treatment is a few hundred dollars a year depending on your geographic region.

The $40k+ price is the cost of the 2x pa injectable form. This is a relatively newer treatment and not widespread.

[UltraSane]

How does wide spread PrEP use affect sexual behavior?

[evoke4908]

Pretty much exactly what you expect given than promiscuity is not taboo in the gay community.

All in all, HIV just isn't a problem anymore. It's on the same sort of threat scale as any other STD. Even if you're infected, you just continue taking PrEP (technically PEP) for the rest of your life and that's about it. Normal life expectancy and not much other health complications for most people with consistent treatment.

[droningparrot]

Drug plans often bring this down to $0-600/year out of pocket

[JumpCrisscross]

It's frankly nuts that we don't make preventative medicine for transmissable diseases free in the rich world. It's so obviously in the collective interest to reduce prevalence.

[mschuster91]

The problem is, as usual, payment.

There have been many failed attempts at developing suppressive, curative and preventative medicine against HIV over the decades, and not all of that was funded by charities or government grants that don't expect repayment - especially not the later stage trials.

[JumpCrisscross]

> problem is, as usual, payment

If only we had an institution with the aim of pursuing the long-term interests of the collective.

[thegrimmest]

We don’t, or at least not everyone agrees we do. Some of us think that we only have an institution that administers peace and order, and believe that pursuing the good is a private, voluntary concern.

[cyberlurker]

Isn’t that the starting price? Insurance and countries can buy in bulk and bring it down. Then overtime doesn’t the price come down due to competition from generics?

[quitit]

The $40k price is the current price in the USA.

Generics aren't possible in markets where the patent holder enforces their rights. The article is about how Gilead will allow certain poverty ridden countries to access the drug without the need to pay a licensing cost (i.e. they can receive a "generic").

[JeremyNT]

Am I wrong in thinking this is a huge development? Maybe one of the most important stories for public health this decade?

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.

[heavyset_go]

There's a shot that lasts a couple months mentioned in the article.

[thaumasiotes]

> Daily pills take a lot of time investment; monthly shots are better

That is a matter of opinion. How much time do you think it takes to swallow a pill?

[t-writescode]

You need to be in the same place, at the same time, every day, and always have them with you, continually. You also need to keep them dry and at room temperature all the time, so no leaving them in your car.

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 :)

[2Gkashmiri]

https://en.m.wikipedia.org/wiki/Directly_observed_treatment,...

This is already possible by DOTS.

In India it did wonders

[slashnode]

DOTS is effective for TB because it’s a time-limited treatment (usually 4 months for drug susceptible strains of TB) and is only relevant for treating infected individuals

DOTS wouldn’t be feasible for a prophylactic treatment like this as the number of participants would be huge and the treatment period is indefinite (ie: the patient’s lifespan)

[saagarjha]

> Directly observed treatment

For a sexually transmitted disease? Harder than you'd expect, considering people are reticent about their private lives.

> short-course

This needs to be continued forever, as far as I understand.

[rcxdude]

It's also quite expensive

[mort96]

I know from experience that I'm not able to take a vitamin D pill every day in the winter months to combat winter depression. It's actually kinda difficult to build habits like that, and I'd have to remember to bring it with me wherever I may go and stay for a couple of days.

[Krssst]

I think I got monthly vitamin D supplements a while ago. Since the body stores it it was feasible to just take one large dose once a month. (however overdosing is still a possibility ; definitely never take a monthly pill daily).

[Lanolderen]

Thanks. I just realized I can just take small handfuls from time to time. I should have been taking it daily but, likely because I don't care for it, I only remember to do so about twice a month.

[b112]

Interesting. Such variance in humans.

I find such things inordinately simple. I wake, stretch, urinate, go take my vitamins and drink two glasses of water. A third follows me to my current home office, where I process emails, alerts, whatever may be.

I find the best time to triage overnight emails is when I'm not quite awake yet to realise I'm doing it. Less pain that way.

The key is it being part of a routine, and the easiest is a part of the wake routine. At least for me. Which is why I find human variance interesting.

Meanwhile scheduling something 6+ months out (a doctor's appointment, or maybe at a pharmacy) for a shot is quite difficult to keep on time. I have to schedule, I have to keep free, I have to keep it in my mental space (calendars on phones help, but still...).

I literally don't know what part of the planet I will be on in a week. How on Earth could I know where to schedule such a thing, months or even weeks in advance?

Yet I bet for the parent poster, scheduling things like this is a breeze. Wild. Totally incomprehensible for me, as maybe it being easy for me to daily schedule is for them?

[n4r9]

How do you ensure that you always have a sufficient stock of vitamins either you, despite being in a different part of the world on a weekly basis?

Do you have kids, if so how do you deal with frequent disruptions to the morning routine? Do you not have days where you just need to get up and go e.g. to catch a flight, get to a meeting, take a kid to school, or because you stayed up late and got drunk, etc... and taking vitamins took a back seat?

[kolinko]

Not vitamins but vrious meds in my case. And a very chaotic lifestyle at times.

The meds are always next to bed, and a pouch with meds for when I travel, plus a set of them in my backpack in case I sleep out of home.

When I was in a relationship and we lived separately, I had two sets - one on my place, another in my gf’s place.

It’s a bit like “how do you manage to brush your teeth daily if you have a chaotic routine”.

[n4r9]

> It’s a bit like “how do you manage to brush your teeth daily if you have a chaotic routine”.

That doesn't move me away from my hunch that the jab is more convenient for many. Studies show that around 30% of people faily to brush the recommended twice a day.

[b112]

I don't have much issue with buying vitamins, because I take them with me. Just as I take toothpaste, etc. If I am there long enough to need more vitamins, it is in the same category as needing more toothpaste, and you resupply as you would at home.

No kids. I do have emergency paging and downed server / PROD to deal with 24/7, not the same as kids, but wake-disrupting all the same.

There is rarely something urgent enough to prevent urinating in the morning, and being thirsty after waking up is typcially a no go either. If prod is down maybe I'll eval first, but humans need out and in of water. I'm not going to urinate on the floor, and I'm not going to sit dehydrated and parched mouth for long either.

So wake, urinate, drink and vitamins are in that too.

My vitamins are in the bathroom, and it takes less than 10 seconds to consume them.

[n4r9]

> I don't have much issue with buying vitamins, because I take them with me.

Nevertheless you do have to remember to pack them, and you need to regularly replenish your stocks. I'm guessing that this replenishing happens at least as often as every 6 months, which is how often you need to arrange the injection in question. By the sounds of it you do a lot of travelling, so you may need to anticipate cases where you are away at the time you would normally replenish stocks.

> you resupply as you would at home

How does that happen? You notice how many pills are left in the bottle, and make a note to order more when it's getting low? Or immediately make an order there and then?

I know I'm being really pedantic, but I'm trying to illustrate why many people would perceive daily pill-taking to be strictly more labour-intensive than a 6-monthly injection.

[thaumasiotes]

> Do you have kids, if so how do you deal with frequent disruptions to the morning routine? Do you not have days where you just need to get up and go e.g. to catch a flight, get to a meeting, take a kid to school, or because you stayed up late and got drunk, etc... and taking vitamins took a back seat?

This is crazy. You deal with the morning routine by taking your pills when the alarm goes off, because there's nothing the kids can be doing that won't wait for that.

Flying, driving, and driving are exactly the same. Take your pill when the alarm goes off.

If you drank so much that it rendered you unconscious through the time you needed to take your pill, the solution is "don't do that". That's not exactly an unavoidable necessity of life.

[viraptor]

> because there's nothing the kids can be doing that won't wait for that.

I feel you don't have young kids then. Jumping on you, bleeding, having a nightmare, making possibly-chocking-sounds, running away with your pills, vomiting on the floor, etc. will definitely take priority over whatever you thought you were going to do after waking up. And that doesn't even touch on people with executive functions issues. Or the 1-2yo period where the time you officially wake up may be often a very fuzzy concept. (You mean the 5am wake-up, the 5.45 one, or the getting up after not falling asleep)

[n4r9]

> there's nothing the kids can be doing that won't wait for that

There are plenty of things kids - especially young kids - will do that require you to push tasks back. Like a vomit, poo, or spillage situation needing immediate attention. Or throwing a tantrum if you try to bring them back upstairs where the pills are (thus waking everyone else up). Not to mention that it can be exhausting if they're not sleeping well - which can be half the time - and it's tough to remember every little thing when you're exhausted.

> If you drank so much that it rendered you unconscious ... that's not exactly an unavoidable necessity of life

You asked "how much time does it take to swallow a pill". The convenience of that depends on people's lifestyles. Lots of people will wake up at 7am in the week, go out and have a few drinks on Friday/Saturday, and wake up whenever/wherever they wake up the next day. That is not an extreme situation. It's a great freedom to dynamically adapt when you go to bed and when you wake up. Requiring a change to that lifestyle is hardly evidence that something is trivially simple.

[Pikamander2]

What's not a matter of opinion is low adherence rates; doctors regularly struggle to get patients take their medication consistently and on time.

Having a shot like this be widely available will be an important stepping stone for eradicating HIV.

[fennecbutt]

As someone who takes prep what a silly question.

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).

[dbbk]

I mean broadly yes but not universally. Some people have fears of needles etc.