Truvada

Friday, July 18, 2014

Transcript

Truvada is a drug that, taken daily, has been show to prevent HIV infection by as much as 99 percent. Like the polio vaccine, or like the birth control pill, it's a medical breakthrough worthy of massive coverage. Why hasn't there been? Brooke speaks to Rich Juzwiak, a Gawker staff writer, about the drug and what’s holding it back in the media.

Guests:

Rich Juzwiak

Hosted by:

Brooke Gladstone

Comments [8]

SF from SF, CA

I didn't know a staff writer a gawker qualified him as a medical expert. Why not interview AIDS experts and doctors who oppose it and let's hear the "other side"

Jul. 23 2014 04:13 PM
John

I didn't think there was any graphic sexual content that required a warning. If the show thought that a warning was needed it should have just said sexual content not "gay sex."

Jul. 21 2014 12:36 PM
AJ

At the beginning of the segment on Truvada, host Brooke Gladstone issued a warning to young and/or sensitive listeners, indicating that parts of the discussion would be about gay sex. While I appreciate Ms. Gladstone's efforts to keep listeners informed, this could have been accomplished by simply stating that the topic of sex would come up in the segment. That "gay" sex was singled out felt like an endorsement of the notion that sex between two men is somehow less palatable than that between members of the opposite sex.

Jul. 20 2014 10:52 PM
Robert from NYC

What you should be investigaing and reporting on is why aren't the pharmacos working on a cure for HIV/AIDS?!! WHY? Because they wouldn't be making the billions of dollars they do by just supplying meds that allow you to "Live with [put your disease/condition here}" times we're living in. Why would anyone want to live with any disease! WHY? Because we've been conditioned to accept this garbage we've been sold by the pharmacos so they can make billions and billions of dollars off of us taking their drugs, and poisonous drugs at that. They should be working on a cure not a cocktail of poisons.

Jul. 20 2014 10:58 AM
jeffrey engel from New York

Despite Brooke's amazing knowledge and sensitivy as a non gay man of the issue, and Richard's articulate advocation of his completely plausible reason for taking Truvada, what is the glaringly absent from this story other than mere comment, and most reporting is the discussion of the absolute importance of ADHERENCE in taking Truvada. Yes, if Truvada is taken every day, the IPREX study (which was tiny, as studies go and on which everyone has based the recommendation to take Truvada for PREP) mathematically modeled and predicted theoretically that daily use of Truvada would prevent transmission. It did not actually demonstrate and confirm prevention. Beyond that, adherence with daily medication is widely known, especially among treating physicians to be amazingly low for all medications in every class, especially for prophylactic meds (even statins and Brooke's example of baby aspirin to prevent heart attack and stroke, bp meds, etc.) The most, but not perfectly, adherent groups of people on meds are diabetics on insulin, HIV positve people for whom HIV is an actual reality, and people with cancer. Even the absolutely wonderful and thorough Brooke didn't raise the issue that if Truvada is not taken everyday (prophylaxis is for something that is abstract, possible, but not yet real) blood levels are roo low to protect from HIV, and people who are theorectically negative, having condomless intercourse will be at risk of exposure and transmission. Many who become infected but do not yet know it will contribute to developing resistant strains of HIV that will render Truvada useless for them and others who are exposed to those Truvada resistant strains of HIV. Truvada is 2/3 of Atripla, and 1/2 of Stribild, 2 of the 3 once/day tablets for hiv treatment. All are meds marketed by Gilead. That is the real reason why Gilead is not openly marketing Truvada as PREP. (This is somewhat different than Brooke's example of when OCPs were marketed for premenstrual dysphoric disorder instead of pregnancy prevention.) Yes, with a big wink, the CDC is advocating PREP with Truvada but only when used with condoms as extra protection. ADHERENCE, is the absolute reason why treating physicians are not all on board the Truvada PREP train. The same people who cannot/will not use condoms every day for prophylaxis, will certainly not be adherent with daily pill taking, let alone regular follow up with their physicians. Just like condoms, one size does not fit all, and Truvada as PREP is absolutely not for the vast majority of men (and women) at risk for HIV. Only time will tell if HIV transmission rates, Truvada resistant strains of HIV, anal gonorrhea/chlamydia/HPV(and anal cancer) will rise.

Jul. 19 2014 08:53 AM
Ramon from Los Angeles

My doctor (at the AIDS Healthcare Foundation in Los Angeles) started giving his patients who wanted it Truvada as PrEP in 2006, but we did not take it everyday, or at least I and my friends didn't. We took it on Fri-Sat-Sun, sometimes Monday during weekends of potentially risky activity. I realize this might be controversial, even feed the fears of folks on the other side of the Truvada Wars, but I feel like what people should really be upset about, if they want to be upset about something, is the fact that this pill has been available since 2004 as treatment and since 2010 as prevention. Why did it take so long for its (potentially) widespread use in this way? There have been some 500,000 new HIV infections in the U.S. over that time. How many of these could have been prevented?

Jul. 19 2014 08:28 AM
Kevin McGruder from Yellow Springs, OH

I was disappointed with the story on Truvada and PreP. Although it was framed as a story about the lack of coverage of PreP, it came across as a story about "what's wrong with gay men for not using this "miracle drug"?" The fact that the "expert" voice for the story was someone who has made the decision to take the drug, and not a medical or public health professional, helped to facilitate this bias. While undoubtedly the drug has real benefits, as a 56 year HIV-negative, gay man, I see very rational reasons for not taking this drug. The drug does have the potential for short-term side effects, as well as long time side effects such as liver and kidney damage. Brook's comparison of taking the drug to taking a baby aspirin is just not accurate, and minimizes the real risks associated with the drug. For me, and I suspect for many other gay men, the option of using condoms, even though it may reduce some of the pleasure of sex, is much more attractive than exposing myself indefinitely to the toxicity of this drug.

Jul. 19 2014 08:25 AM
Mark from NYC

Great reporting. After umteen years of prevention education, the fact that there are 50,000 new HIV infections in the U.S. every year remains stubbornly unchanged. The fact that "1 in 6" (that's 16%) men who have sex with men admit to using condoms also, as Brook points out, means that this preventive pill is definitively not disrupting anything near a perfect system.

I believe that the renal toxicities and bone osteopenia risks have been downplayed, but perhaps they are less of a risk in healthy, HIV-negative men. I worry about the risk of the development of resistant virus. I also wonder if the pill actually needs to be taken daily. (It is very likely that it could be taken every other day, at a minimum, and possibly less frequently: look at the intracellular half life of the 2 meds in the pill.)

I also worry about drug-resistant strains of gonorrhea, syphilis. And the spread of HPV and HSV, but at least these are not lethal infections.

But imagine if this could prevent even 1,000—or 10,000—new infections in the U.S. each year. That would be the best news on the prevention front since the observation that persons on effective treatment do not transmit the virus. We should all be shouting, Ned Weeks included, HOORAY.

Jul. 19 2014 08:00 AM

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