As far as I can tell, what's going on here is that there are multiple stages of antibody development. People have circulating B cells, and these cells have their genomes modified by the the VD(J) recombination process [0] from the genome in the human germline (i.e. what your germline cells and most of the non-B cells in your body have). There are a large number, but nowhere near infinite number, of B cells and corresponding antibodies that can be produced in this process, and I think these are what the authors call "germline" cells.
Once a naive B cell decides that it encodes a useful antibody (which is a complicated process), it starts to divide. Some of the daughter cells further mutate in a process called affinity maturation [1] to produce what are hopefully even better antibodies.
I think that the idea behind this research is that there are certain antibodies that can be produced by affinity maturation that are very useful against HIV, but that the "germline" B cells that lead to these antibodies are not particularly likely to be selected by the immune system when exposed to natural HIV antigens. Instead, the researchers have developed customized antigens intended to target specific germline cells which are known to be able to mature into cells that can produce the desired antibodies. If this works, the next step would be a series of additional vaccines (which are not the same as dose 1) that will try to encourage maturation into the useful antibodies.
The takeaway is that this result is very promising and that there is (so far?) no reason to expect the trial participants to be immune to HIV.
For the ML crowd, another way to think about this is that, when your body is exposed to an antigen, it runs a massively parallel search algorithm to find good antibodies in a truly massive space of possible antibodies. Unfortunately, most people, when exposed to real HIV or to prior vaccine attempts, get stuck in a bunch of not-fantastic local minima. The idea is to specifically aim the search in the right direction so, after a few rounds, it can find a better solution.
* VRC01 was shown around a decade ago to be one of several antibodies generated...that achieves broad neutralisation of several HIV strains
* 97% of participants who received an HIV vaccine immunogen candidate developed VRC01-class IgG B cells, precursors to broadly neutralising VRC01-class antibodies
* Results from another set of studies presented at HIVR4P (the Antibody Mediated Prevention [AMP] trials) showed that although intravenous administration of the VRC01 antibody at 8-week intervals did prevent infections with some strains of HIV, only 30% of the strains circulating in the trial regions of sub-Saharan Africa, South America, Switzerland, and the USA were sensitive to VRC01
To me this appears to be a great breakthrough but doesn't seem like a silver bullet.
In particular, how easy will distribution be, considering that HIV is extremely easily preventable but it still spreads, because of lack of distribution of knowledge, I assume.
> In particular, how easy will distribution be, considering that HIV is extremely easily preventable but it still spreads, because of lack of distribution of knowledge, I assume.
This is a huge problem in the US. Truvada must be taken everyday to prevent HIV, and in 2015, it cost $1400 for a 30 day supply. In 2021, it costs between $1900 and $2500+ for a 30 day supply in the US.
Elsewhere in the world, Truvada might cost $40. In Australia, Truvada costs $8 for a 30 day supply[1].
The only other drug approved for PrEP in the US is Descovy, which is manufactured by Gilead, too, and costs $2300+ minimum for a 30 day supply.
No guarantee the price will go down in the US as a result.
An epilepsy medication I took, once the patents completely expired (both on the regular and extended release versions), the generics ended up costing me more to pick up while the branded version rose in price as well.
It typically takes about 6 months to 3 years for generic drug prices to decline due to how we approve generics in the USA. Most people don't know that we have an insane policy whereby the first generic drug applicant receives an extended period of market exclusivity.
"Most people don't know that we have an insane policy whereby the first generic drug applicant receives an extended period of market exclusivity."
The US has some of the lowest cost generics in developed nations - prices tend to be lower than the EU. The US has some of the highest generic drug penetration of developed nations. [1] That's because of things like the 180 generic drug exclusivity and mandatory generic substitution laws.
The 180 exclusivity is a big part of that. If you open the flood gates to any generic manufacturer, the margins disappear so quickly that some manufacturers won't even bother to try. By dangling a massive carrot whereby the generic manufacturers can quickly recoup costs and make a large profit, it drives generic companies to compete to the enter the market.
When Lipitor went off patent, eleven generic companies entered the market and prices dropped 95%.
The US generic market is one of the best functioning in the world.
> Elsewhere in the world, Truvada might cost $40. In Australia, Truvada costs $8 for a 30 day supply[1].
AUD 6.60 in Australia is the cost for those eligible for the concession PBS rate (those that are on welfare, pension etc.). It's AUD 41.30 for everyone else.
This is all thanks to our government negotiating a good rate with the manufacturer and then subsidizing the costs. This is not what all governments do, unfortunately.
I looked up pricing of Truvada vs. Descovy through my insurance, and weirdly Truvada would be a $40 copay, yet Descovy is $0 as insurance covers the entire obscene amount ($~2200 for a 30 day supply).
Medical insurance companies know they get a slice of the pie, so the size of the pie is really, really important to future growth.
Also, can't help but wonder if your insurance company has an ownership interest in Descovy...somewhere. $2200 is cheap if you're paying it to yourself. And the pie grows.
Yeah, that's my mildly paranoid writing for the week, methinks.
Why doesn't the US pass a law that prevent such large deprecencies? Is it because the legal landscape is different and pharmaceuticals companies worry about the cost of litigation in the US?
Because Big Pharma lobbies to prevent such laws from being imposed. There’s even a law that prevents Medicare from negotiating down the price of drugs, with obvious consequences.
Because the GOP is ideologically opposed to price controls (except when it's in the form of subsidies to their state's pet industry of course). Something, something, free market distortions I think is the usual reason.
I think you’re misguided if you think this is a partisan issue. It’s an American issue where neither party has really adequately done anything about affordable healthcare and gouging like this.
Everything that has been done or been tried has had to pass or be written under the specter of the filibuster though. It fundamentally limits the type of options that get through. The only major change in the last decade was Obamacare which is remarkably similar to the system passed under a the Republican Governorship of Mitt Romney.
Democrats have some options they'd like to do that might help but cannot because of the filibuster. Reconciliation which is the only way around the filibuster guaranteed is pretty limited in scope due to the rules around it. Whether those could pass a vote if there was no filibuster is unknown because they all get completely blocked by Republican filibuster.
> The only major change in the last decade was Obamacare which is remarkably similar to the system passed under a the Republican Governorship of Mitt Romney.
Which itself was a state level implementation of a program the insurance industry and national Republicans were talking up as an alternative in the 90s when, i the wake of the failure of Clinton’s healthcare reform, it seemed there was enough residual demand for something to be done in that regard nationally that they thought they needed to bring something to the table.
> Democrats have some options they'd like to do that might help but cannot because of the filibuster.
Repetitively, issues are raised and forgotten by politicians, and never actually solved by the party in power. For various reasons, many people have come to believe propaganda about the filibuster. For example, Sen. Warren and others say that the filibuster is racist and a relic of the past, yet Democrats (including Warren) filibustered the Republican's $500 billion coronavirus relief bill in September of last year. They were really saving their votes to send you money after the election. They also filibustered a Republican police-reform bill last year.
While the parties do not necessarily hold the same platforms as each other, many of the Senators literally went to school in order to become politicians. They are not your friends. They are prevaricating in order to remain in power and make money. Not all - but many of them. Warren has some redeeming qualities, but facts are facts. She has been a Senator since 2013 and has had her own share of "clarified statements".
Definition: A wedge issue is a divisive political issue, especially one that is raised by a candidate for public office in hopes of attracting or alienating an opponent's supporters.
These wedge issues are used to keep people's emotions going, so as to vote for one party and hate the other. Then, the issues are not solved a the times they could. There is a reason for the existence of an actual term, wedge issue, for the concept - because it constantly happens.
The filibuster is a set of rules that both parties agreed to. One might well ask why Democrats in the senate agreed to this rule once again, knowing full well it would impede their ability to accomplish their publicly touted platform over the next few years.
Kind of, the filibuster isn't so much in the rules as it's a consequence of other rules and (imo) a poorly designed government. The Senate was originally setup with truly unlimited debate, this is a pretty bad idea on the face of it because it allows a pretty small group to potentially completely stall the whole of the US government's law making apparatus. [0] So cloture was added which added a way to officially close debate on a bill to avoid that. It requires more coordination but still introduces an extra veto point into the government that most modern democracies don't have. It's an extremely powerful tool for the minority.
That very power is a reason I think there's a few hold outs on the Democrat side that don't want to get rid of it. The senate is naturally stacked against the democrats as the parties are currently aligned so a few don't want to risk giving up that power. There's also a number who (at least claim to) believe that the unlimited debate is an important part of the Senate.
Personally I think it's a relic that's getting in the way of passing the exact legislation that will make Democrats more popular (and make it easier to vote to counteract some extremely blatant voter suppression happening in red states).
[0] consider 3 senators working 8 hour shifts of 8 on 16 off. That would be maintainable for a very long time.
The US govt is heavily calibrated on the side of minority political factions in order to protect minorities from “oppressive” majority rule. It’s annoying when it gets in the way of the majority but also fundamental to how the US operates. What recent events tell me is that we’re looking to the federal government to do more than it is/was meant to do. If that’s dated so be it but I dont understand why states have to wait around for the federal government to solve healthcare.
For starters the Federal level has access to waaay more money and sources of money (including just 'printing' money, investment taxes, etc.) than any state and the larger the population the more power a government has in bargaining. It's also much easier for companies and people to just abandon a state to avoid paying new taxes than it is for them to leave the US entirely.
The power of the minority was a crappy compromise to get the less densely populated states (not coincidentally southern slave owning states) to sign on to the constitution. The original Articles of Confederation were even worse requiring basically unanimity to pass federal laws and taxes. The whole job of the Senate was to appease those same states. Do any other countries have this kind of explicit carve out for land (essentially) getting an equal weight?
> It’s annoying when it gets in the way of the majority but also fundamental to how the US operates.
I think a government where the majority party can't actually implement any kind of agenda is a fundamentally broken government.
> I dont understand why states have to wait around for the federal government to solve healthcare.
Because they're ironically forbidden by federal law. Several legislators in CA would love to bring a statewide single-payer healthcare bill forward, but funding it would require using federal Medicare dollars in ways that require permission from the US Congress. Guess how likely that'll be forthcoming?
> I think a government where the majority party can't actually implement any kind of agenda is a fundamentally broken government.
I think this is a big sustaining source of disillusion with the US government. Cynical minorities have a pretty easy way to make people hate the opposition by just blocking everything, this was even explicitly acknowledged by McConnel as their strategy. Block everything no matter how small.
I get it and don't agree with what the current republican party is doing, but that’s almost besides the point. If we can’t get an agenda accomplished then perhaps it’s too overarching to be agreeable to or considered fundamental by most of Americans.
Now, it’s also possible that we’re suffering from the two party hell we’ve created and that we have an overstated (too large) minority party that doesn't reflect the wishes of any reasonable fraction of our people... I tend to think this is more of a problem than people realize. We need voting reform to bring more plurality into govt operations and lawmaking.
> If we can’t get an agenda accomplished then perhaps it’s too overarching to be agreeable to or considered fundamental by most of Americans.
Republican Senators don't seem to care if an agenda is supported by a majority of registered Republican voters.
Anyhow, the Senate must be reformed or abolished. Land does not require representation. Give every state a guaranteed 2 senators, I suppose, but some reasonable formula should be implemented that apportions more populous states additional senators.
The obvious answer is eventually they will be out of power again and will want it. In fact until a few years ago they had it for judges, but they got rid of it when Republicans filibustered. Then when Trump nominated a judge they didn't like, well they discovered the filibuster was gone by their own doing and they were powerless.
That's not true. Mitch McConnell got rid of the SCOTUS 'filibuster' lowered it to 51 votes - pretty hypocritically based on his statements but you can't take McConnell's word you have to look at what has power.
Harry Reid previously lowered cloture threshold for non SCOTUS appointments, but only after Republicans act(ed) in bad faith and refused to "Advice and Consent."
They refused to confirm 2 very important seats for 'cost savings' and claimed that the DC circuit was 'underworked.' This is in the context of anti-Obama everything and no matter how milquetoast the nominee was.
that obvious answer is not a good one. when democrats got material gains for working people they controlled congress from 1933 to 1980 except for two years. getting rid of the filibuster and packing the supreme court to pass and see to fruition real material gains would make democrats the ruling party for the foreseeable future. they don't do that because that's not what they want.
The obvious answer isn't really applicable here, though it does cross the lips of plenty of moderates. The reality is that the Democratic party is forced into being a "big tent" party of "everyone left of the Republicans," which represents a simply massive spectrum, and therefore they have less consensus than the Republican party. Take, for example, Joe Manchin, a Democrat from West Virginia who drew some ire after FiveThirtyEight found he sided with Trump's priorities 58% of the time. He's been vocal that he would never agree to eliminate the filibuster, because he's basically a Republican in all but name.
As an international who is not as familiar with American politics (but wants to understand), why is this comment being down voted? Are the claims incorrect? Are they unsubstantiated?
As the person who wrote it, I'm not sure; I think this one of those things that's colored by opinion as much as fact. I would like to hear someone say what they think.
The bit about Manchin is fact, though. They can't change the rule without him, and he doesn't want to eliminate the filibuster. He did say that he would consider modifying it to make it more difficult, however.
It's being downvoted because it ignores the same issues on in the Republican party. Anyone who thinks either party is some monolithic blocks that all votes the same way hasn't been paying attention.
Manchin is doing theater to appeal to his voter base, who are indeed largely not in his party.
He's being far more cooperative than, say, Liebermann was while passing the ACA, and his actual goal is to say he's fighting those out of control big city liberals by keeping the filibuster, but the changes he'll allow will make it completely different and more or less how it was in the 90s.
Sinema also wants to keep it and seems to actually be a true believer, which is dumb and not even what her voters want, so who knows what's up with that.
I always forget about Sinema, which is something I need to stop doing because, as you say, she's probably the true believer.
I don't think we can be too charitable towards Manchin considering his other stances. That said, you raise a good point: changing the filibuster doesn't really change his position; he's still an essential vote to pass any legislation in a tied senate, so he benefits from either outcome. I suppose, all other things being equal, it makes sense for him to nominally oppose ending the filibuster for the sake of his base.
Because they're just as correct when you switch the labels.
With two parties both jockey for position in being as close to center as possible while still appearing unique. To leave the center is to sacrifice those voters to the opposition. This is why first past the post voting is stable yet nearly useless.
Democrats consist of actual liberals, marxists, authoritatians, etc.
Republicans consist of actual fiscal conservatives, the religious, libertarians, etc.
Both are unhappy alliances and occasionally fracture and spill one of these constituencies and the opposition rushes to appeal to them.
Obamacare has an annual out of pocket cost cap of ~$6300 on healthcare including prescriptions.
Sure, that is still pretty high, but it basically saved my life. If not for Obamacare I would need to come up with over 300k per year to not get very sick.
This isn't an either party is the same situation. One party would let me be seriously ill. One would give me a possible solution.
The problem is that it can always be taken away from you. Remember, the Affordable Care Act ruling is supposed to come out this summer.
I am on an orphan drug myself (subcutaneous immunoglobulin, which I am self-infusing at the moment...) which costed $278,000/year under contract, when I lived in the US. Of course the provider bills a much higher amount. But the figure I gave is the one that is paid out, over the course of a year.
You should know that the third leading cause of death in the US is believed to be preventable medical errors. This has been corroborated via multiple follow-up studies, just google "third leading cause of death US medical errors". But, here is the original article: https://www.bmj.com/content/353/bmj.i2139
You can go to the "best hospitals", have the "best insurance", and "be able to pay for care", but you cannot evade a statistic like that. The medical error rate is on par with developing countries, by the way.
Also, 7-8% of the general population collectively has some sort of rare disease, which is theoretically treated by orphan drugs. There are now orphan drugs that cost $2 million/year per person, and the cost is so extortionate that it is literally going to screw over the US health system. Such meds have to be taken for life.: https://www.nytimes.com/2019/08/25/health/drug-prices-rare-d...
Also, life expectancy does not look so good in the US.
US was 43rd worldwide in life expectancy in 2016. In 2040, we are expected to be 64th.
Honestly, this kind of stuff is why I emigrated and I am a dual US|EU (Croatian) citizen. As an EU citizen, I have Freedom of Movement rights to live/work/retire in 30+ countries within the EU and EFTA (minus Liechtenstein--has an immigration quota).
Because of your health status, Canada, Australia, and New Zealand are off limits because they have strict medical inadmissability clauses in their immigration laws. I would stay away from the UK too, because they could implement such rules post-Brexit.
But, I have studied healthcare systems, logistics of healthcare, along with rules for acquiring citizenship, for hundreds of hours. If you want any help or advice, feel free to shoot me an email (check my profile).
You know about the filibuster right? Republicans can filibuster (force infinite 'debate' though modern rules don't require people to actually talk during a filibuster any more [0]) anything they don't want to pass and it's up to extremely centrist (barely) Democrats like Joe Manchin if the filibuster remains. Without removing that it takes 10 Republican votes to stop debate on any bill.
There are some work arounds but they're limited to things that one person decides are sufficiently budget related enough to go through the reconciliation process that prevents filibusters. And that is a thrice a year option at most.
[0] I get why since senators have all sorts of commitments to their time even counting just Senate business but it means a there's basically no cost to doing one where there was.
To be clear, the Biden administration issued a regulatory rule freeze memorandum, and that's one of the things that was frozen. Has any decision since been made whether to implement the rule?
Worth noting that no one pays $1400 a month. Their insurance covers it, just like insurance covers you in Australia or Germany or Canada or anywhere else.
But then, doesn't that mean everyone with coverage pays for it?Insurance pays for it, and everyone with coverage pays for these high costs through high premiums -- public healthcare in Canada doesn't pay for drugs, and even without insurance the cost of those drugs tends to be substantially cheaper, at least in the few scenarios I've been exposed to.
I mean 225,000 Americans are on it, and multiply that by 1400 x 12, and you're already way past Truvada's global annual revenue. The numbers don't work out.
Americans do subsidize European and African prices though, there's no doubt about that.
More likely it means you pay (or more appropriately, your insurance company pays) the negotiated rate, which is often far, far less than the published retail cost of a medication.
Those big monthly $$s get investors excited tho.
This is to say nothing of the public / private debate.
There are millions of people with deductibles that are in the $2000 - $8000+ range, and even higher for family plans. Those people are certainly paying $1400 for several months until their insurance kicks in. Then, in the next coverage year, they get to spend that $1400 several times again, and they continue that pattern each year.
If their insurance doesn't cover it, they're also paying $1400.
If you are insured and look at medical bills in the US you generally see an obscene top line cost, a very large discount that the insurance company negotiates, and your personal copay. That discount doesn’t really seem to come from somewhere.
It costs quite a lot to take any given new drug to market (one study suggested a median of 0.985 billion, and a mean of 1.3 billion), and most of them do not make it. They must recoup expenses somehow, or go broke, and then ... no new drugs. To that end, they get a limited period of exclusivity over their invention.
Now, is this done efficiently? I don't know. Perhaps the FDA approval process could be less costly. Or we could limit litigation in some manner. And so on.
But they're sure not gonna churn out new drugs for the cost of some generics.
While I can appreciate that drugs _do_ cost money to manufacture, it does not mean that people should be expected to pay hundreds or thousands for a drug that is vital to their health.
The money comes from somewhere. You can make it direct or you can make it indirect, but it is still coming from one bank account or another.
Essentially, the US is footing the bill for the world. If you look at overseas pharmacies, PReP has been available (as are many drugs) at very cheap prices for quite a while now. Some countries just ignore the drug patents and go on their merry way. Our current method of accounting inside the US has people pay into insurance, which then pays out for these particular drugs.
Instead of making a smart-ass comment, I was prompted by your reply to look.
Some non-profit pharmas do exist, but it appears that they are largely focused on generics or orphan drugs. I have seen some press-release stuff on how some of them could work in drug discovery, but it was always a team-up with someone else, and I couldn't find what new drugs had actually made it to market from non-profit pharmas.
I suppose the only way to really prove this one way or another would be to select the last thousand drugs to market globally, note the country of origin and the company, and whether or not they were for-profit or not. Perhaps build out on that -- how much did it cost to bring that to market? How many failed per pharma?
So two valid arguments to have: drug discovery, & whether 'market incentives' give us cheaper & more drugs.
My main point is looking at this holistically profit is a huge % and a terrible incentive for both what drugs are pushed and trialed and how much they can gouge us to benefit their shareholders.
Gilead is 79%... More than 2x apple. [1]
That is ethically wrong.
Government already funds (most seems like this research article sats? [2]) early stage research e.g. discovery. Then the drug companies take the best looking candidates but they have gross incentives to pick the most potential profit, not the most benefit to society (like HIV a so far lifetime disease where our lives are dependent on this medicine) - why pay to research a prodrug or big stage 3 trial on a drug you cant make money on.
In terms of 'market incentive' on the manufacturing side manufacturing costs themselves are tiny [4] and if anything my intuition is it has a net negative effect on quality. these companies try to penny pinch and push the every lessoning government oversight to its limits & offshore production with dangerous JIT supply chains and single source failures. Plus Republicans refuse to allow the government to negotiate or 'interfere' with 'the market' in the name of 'market incentive' kudos to trump to buck the party though.
and it also seems setting up a non-profit is currently hostile by the system our government has concocted because of pharma lobby & their ad persuasion $ [3]
We had a president that addressed this but people didn't like that he sent 'nasty' tweets. then his successor overturned the order and we all celebrated.
Can you please stop posting unsubstantive and/or flamebait comments to HN? You started out with a good post (https://news.ycombinator.com/item?id=24915604), but since then have been breaking the site guidelines.
I remember him making a lot of noise about making insulin super cheap or giving us the best and cheapest health plan to replace obamacare, he had a full 4 years in office to accomplish this, including two years with complete control of congress. So what exactly did he accomplish?
Trump waited until 2020 to sign a bunch of fake healthcare EOs that had little chance of being implemented. What was he doing the previous 3 years on healthcare beyond trying to strip all of it away???
He only did this to distract from COVID and even when he wrote the EOs everyone said they were going to get jammed up in the courts forever.
I'm not going to play pretend about things trump really truly wanted to do but waited 3.5 years until the middle of a pandemic, and then never implemented.
OK, I'm legitimately curious to know more. I do remember him talking about "making insulin as cheap as water" or something like that, but can you point me to the actual executive order or bill he was trying to pass that dealt with this issue of lowering the cost for prescriptions? A source about Biden overturning whatever it was would be great as well.
I don't preclude Trump from having actually done something meaningful, but a lot of what he does is vain and self-promoting, so I could easily see this being a case where he tried to put something into effect that looks good on the surface but doesn't actually accomplish anything, or doesn't accomplish it in a sustainable way and thus would need to be revoked to prevent prices going up in the long term.
Interesting that the UK-based Independent did this reporting without mentioning that the NHS still hasn't issued approval for Truvada to be provided outside of trial programs.
Cost to the enduser seems to be the most important metric when you want people at risk to actually take the stuff to prevent the spread of a deadly disease.
I don't know anyone who's actually paying for PrEP here in the US because pretty much every provider's going to cover it, no? It's more expensive treat HIV than it is to prevent it, so if you're an at-risk individual your insurance doesn't want you getting it
Several insurance companies like UnitedHealthCare had to be sued into covering PrEP. Not many insurance companies are going to happily cover a medication that can cost ~$30,000+ a year to fill.
Even now, United is making it clear that they don't intend to cover new PrEP medication like Descovy even though the medication doesn't cause as much renal damage and failure as Truvada does: https://www.beckershospitalreview.com/payer-issues/unitedhea...
If you have a high deductible insurance plan, it is not going to be fun to pay for your first few months of PrEP entirely out of pocket. Many people are priced out of PrEP because of that, as are the uninsured and underinsured.
Exactly. It's like assuming everyone has a Mercedes, a smartphone, or a butler. M4A is also not a solution for universal healthcare because Medicare isn't very good: it requires multiple types of paid co-insurance, rations healthcare, and doesn't pay doctors enough to motivate them to help patients. Medicare is a bare-bones, half-measure that doesn't offer a healthcare system. The common refrain of "It's better than nothing" is an invalid rationalization to settle for substandard healthcare.
FDA, however, has a policy explaining that it typically does not object to personal imports of drugs that FDA has not approved under certain circumstances, including the following situation:
The drug is for use for a serious condition for which effective treatment is not available in the United States;
>> You are gonna die and they have something not in the USA that could save your ass
There is no commercialization or promotion of the drug to U.S. residents;
>> You are fine as long as you do not compete with US drug companies
The drug is considered not to represent an unreasonable risk;
>> This could literally mean anything. Who defines what unreasonable risk means? And you are comparing the risk of the unapproved drug with what exactly? You are certainly not comparing with the risk of death by not having access($$) to some drug you need
The individual importing the drug verifies in writing that it is for his or her own use, and provides contact information for the doctor providing treatment or shows the product is for the continuation of treatment begun in a foreign country;
>> Again you are forbidden to compete with US drug companies
and
Generally, not more than a 3-month supply of the drug is imported.
>> And even if the drug could save your life and it's not available in the US you still have to play this stupid traveling game every three months. I'm sure most people with chronic illnesses love to burn their money being forced to travel due to some arbitrary regulation
If you look at the link below, you’ll see that the 70% figure comes from a study of repeated sex over time (with self-reported condom usage), and so can’t be applied to the figures for a single sex act. Preventing semen from coming in contact with the vagina/anus will reduce transmission risk to effectively zero, and condoms don’t break all that often.
Correct condom use will make you as an individual much safer. But as a public health strategy, telling people to use condoms has a significant but limited effect.
Wow that link has been super informative, thank you! I knew that the transmission risk was actually lower than commonly thought but wasn't aware that it was direction- and sexual act-dependent, nor that condoms were of great but still limited effect. Thanks!
In fact, receptive penio-anal sex has about 17 times as high a transmission rate than receptive penio-vaginal sex, which an order of magnitude more difference than what a condom can make in either.
The difference a condom makes is quite comparable to being the receiver or penetrator in penio-vaginal sex, in fact.
As I understand it, only one company makes the generic right now.
As others begin producing it market pressure will hopefully drive those costs down.
It’s also worth noting that some insurance companies have recently begun classifying it as preventative medicine (as it should’ve been this whole time) and covering it at 100%.
> One of the ways branded drug manufacturers prevent competition is simple: cash. In so-called “pay for delay” agreements, a brand drug company simply pays a generic company not to launch a version of a drug. The Federal Trade Commission estimates these pacts cost U.S. consumers and taxpayers $3.5 billion in higher drug costs each year.
and this fun one...
> Another way pharmaceutical firms are thwarting generics is by restricting access to samples for testing. Generic drug makers need to be able to purchase a sample of a brand-name product to conduct bioequivalence testing. That’s because they have to prove they can make a bioequivalent product following the current good manufacturing practices (CGMP) standard. These manufacturers don’t need to conduct clinical trials like the original drug company did.
> But the original drug developer often declines to sell drug samples to generics manufacturers by citing “FDA requirements,” by which they mean the agency’s Risk Evaluation and Mitigation Strategies program. The idea behind this program is a good one: give access to patients who will benefit from these personalized medicines, and bar access for patients who won’t benefit and could be seriously harmed. However, brand drug makers are citing these requirements for the sole purpose of keeping generics from coming to market.
Thats collusion and its supposed to be illegal. Maybe the US should enforce the laws it has or get more teeth in anti-trust cases by expanding the definition.
That's not how the system works. The first generic get 6 months of market exclusivity. The FDA won't approve any other until after the 6 months is up.
And if one generic manufacturer was able to get approved, then the flood gates are open. It won't limit anything if all those additional patents were found invalid (which they would need to be for the 1st generic to be approved).
Generic medicines also require licensing, which costs money and takes time. A whole lot more could be done by governments to facilitate more competition in generic drugs.
I stand by what I said. On a worldwide revenue basis, there are many other manufacturers that have strong incentives to develop a cure. Also, I disagree that "PrEP" would eliminate HIV. It's a prophylactic, not a cure, and one that will not be affordable globally for a looooong time. Even at $30 per month, the drug would be out of reach for many (see Africa where annual incomes hover around $1-2K annually.)
1. Gilead owns 3 of 4 top HIV drugs. GSK owns the #2, Triumeq.
2. GSK, Merk, J&J are all megacap, viable competitors with their own HIV products. Yes, its true that Merk and Gilead are in cahoots, but this was out of fear of GSKs dominance.
3. Some other US-listed names who are developing HIV drugs: ViiV (GSK subsidiary), Bristol Myers Squibb, Janssen, Mylan, Genentech, Abbvie.
Yes, the US is currently dominated by one company, but that does not mean there are heavy incentives for competitors--who are already well invested in the space--to break in.
This vaccine doesn't prevent infection by HIV so it's not ready for real world use. What it does is prime the immune system so that a second vaccine might become more effective. The second vaccine still needs to be developed though
From NPR interviews I listened to during the early days of the mRNA vaccines showing incredible promise, I understood that one of the problems with HIV is that the human body does not naturally have strong defense mechanisms (antibodies, etc) for this type of virus. Hence, the usual vaccine path (or mRNA derived method) of accelerating the learning of the body's T-cells, etc. to manufacture its own defenses is not very effective -- they are not there to begin with.
Is that not correct? What are they doing differently here?
Passive immunization with broadly neutralizing antibodies have been shown to prevent HIV infection in various animal studies. The goal is apparently to make the immune system able to manufacture such antibodies. The human immune system is fundamentally able to come up with these antibodies on its own, as some HIV positive individuals do develop them, but at least during natural infection they don't appear in everyone.
However, antibody levels won't be as high in vaccinated individuals as they are in those passive immunization animal studies, at least not forever. The body can't afford to produce full levels of antibodies for all antigens all the time. Instead, human bodies reduce produced antibody levels some time after the event that triggered the production of the antibodies. The immune system remembers the antibodies it has come up with, and can ramp up their production quickly if the antigen is re-encountered, but the question is whether this reaction is quick enough to prevent HIV infection. IIRC people with who produce broadly neutralizing antibodies naturally still eventually develop AIDS, if left untreated. Time has to tell if vaccinated individuals behave more like those animal models, or more like that subset of people who produce broadly neutralizing antibodies a few years post infection.
Until now, every vaccine for HIV has failed, and there have been many attempts. But you never win if you never try :).
My understanding is that many HIV vaccine candidates have showed promising Phase I results but so far they have all failed in later trials.
https://en.wikipedia.org/wiki/HIV_vaccine_development lists five vaccines that made it to Phase 2-3 (and all failed). Two of them appeared to increase the risk of contracting HIV. The strongest candidate appears to have been ~30% effective.
Interesting that there was some warnings given about using the same vectored technique on a Covid vaccine (AstraZeneca is an example) could also potentially increase the risk of contracting HIV? https://www.ajmc.com/view/researchers-warn-of-heightened-ris...
Note that Johnson & Johnson and AstraZeneca use different adenoviruses as vectors than Merck’s failed Ad5 vaccine.
> ...the vaccine successfully stimulated the production of the rare immune cells needed to generate antibodies against HIV in 97 percent of participants.
This is not the same as creating a 97% antibody response.
The article goes on to say that it's part of a mutli-step process to create immunity, so it seems this initial shot is not enough.
This needs more clarity from someone with expertise in the field.
Browsers not showing full URLs were the first bad thing, but now articles are linking to domain names, which makes those links unusable for cross-checking references.
At this point, no one knows if it actually prevents HIV, just that it produces a immune response (which can be detected through blood tests) which indicates that it could.
In general, it is possible that an HIV vaccine could lead to remission of pre-existing infections, but it's impossible to know yet if this one would do that.
The vaccines that I'm aware of only prevent infection in people without HIV. You can look up the vaccines on clinicaltrials.gov and find out their efficacy in different populations.
> The Swazi population faces major health issues: HIV/AIDS and (to a lesser extent) tuberculosis are widespread.It is estimated that 26% of the adult population is HIV-positive. As of 2018, Eswatini has the 12th-lowest life expectancy in the world, at 58 years.
> Africa really needs to be the target rollout for these vaccines if and when they materialize.
I'm not sure why this is downvoted. Africa is the most affected continent of the HIV pandemic.
> Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total infected worldwide – some 35 million people – were Africans, of whom 15 million have already died. Sub-Saharan Africa alone accounted for an estimated 69 percent of all people living with HIV and 70 percent of all AIDS deaths in 2011.
If you continue to post unsubstantive and/or flamebait comments to HN, we will have to ban you. You've been doing it a lot, and it's not what this site is for. Please review https://news.ycombinator.com/newsguidelines.html and fix this.
Actually your account appears to be using HN primarily for political/ideological battle. We ban that sort of account, so please don't.
Treatment is both expensive and taxing on the body, the drugs can cause renal problems and even renal failure. Multiple drugs need to be taken, they'll need to be switched up, and you'll need regular blood work to make sure that they aren't destroying your organs. You're going to need to see expensive specialists regularly for the rest of your life. You aren't going to only fill a prescription and take a pill and have that be the extent of your treatment.
There are several different and relatively large populations for whom complications can arise with treatment, like those with weakened immune systems, organ transplants, kidney disease, the elderly etc.
If you're wealthy and in otherwise good health, then yes, HIV is a relatively solved problem for you.
If there was a cost-effective cure, we could consider it solved. The only (functional) cure for it involves basically taking a sledgehammer to the entire immune system and replacing it with one from a donor with CCR-5 delta 32. As far as anyone's aware, this was only done with 2(?) patients who also had blood cancers.
Everyone else is popping antiviral cocktails and living with both the stigma of the disease and the risk of a relapse if they ever end up not being able to afford the drugs.
So... not quite solved. Hopefully this'll get us closer.
I'll answer the question to the best of what I know. It appears that there wasn't a problem to start with. Luc Montagnier, one of the co-discoverers of the AIDS virus for which he got the noble prize, is on record saying that it is a benign virus and in Africa at least is related to malnutrition. So unless the video is doctored one can take his word to be gospel. He is a heretic, btw.
Then there is Kary Mullis a noble prize winner (in chemistry) and the developer of the PCR test, who on investigation could not find any paper which indicated that the AIDS virus has been isolated, hence concluded that it's not proven that HIV causes AIDS ( or something to that effect).
If you cannot find the relevant videos on you tube search bitchute.
No it isn't. The costly treatment can have heavy side effects... for the people who can afford it, i.e. not most of people who are infected in Africa...
On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity."
> Now I'm curious what a good website for vaccine news is ...
Health science journals or communities perhaps.
I was triggered by seeing multiple posts about AstraZeneca blood clot all from major news websites. But somehow I ended up leaving comment on this post unintentionally.
For that (COVID-19 vaccine updates) I like NYT vaccine tracker[1] and Our World in Data[2] but I don't really check them regularly since it's impossible to miss any COVID-19 related update these days anyway.
Because as a member of the community, He is trying to shape the discourse and culture here. We all should be doing that, to maintain the high quality content.
> He’s a bigoted right-wing conservative who doesn’t want to hear about interesting scientific developments that he views as benefiting people with lifestyles that he condemns.
Perhaps not here, but I think this is a view worth discussing. I'm moderately conservative, and some of that comment's criticism resonates with my own thoughts.
With cases like HIV/AIDS, I find myself pulled between several competing virtues:
One one side there's mercy and compassion; I'd like to minimize the suffering of hurting people. Even if someone is in dire straights because of actions that I view as unwise (extramarital sex, recreational drug use, etc.), I still want to want what's best for that person.
On the other side, there's justice. I live in a society where everyone pays, to some degree, for individuals' unwise behavior. E.g., Medicare/Medicaid for smokers' lung cancer or HIV treatment for persons who chose to indulge in risky behavior. I'm not okay with forcing the community at large to cover the costs of (what I view as) individuals' selfish actions.
I don't know what the right balance to this is. More generally, I'm not sure if there are any good principles for finding the right tradeoff between two virtues. I wish I knew. I want to do good, but the path is often obscure.
You can flip peoples' tribal affiliations on this topic by changing the disease to COVID. Do red-state antimaskers deserve treatment? Should responsible Americans pay for their reckless lifestyle?
> You can flip peoples' tribal affiliations on this topic by changing the disease to COVID. Do red-state antimaskers deserve treatment? Should responsible Americans pay for their reckless lifestyle?
Personally, I'm not sure. As I said above, I'm conflicted on the issue.
Regarding anti-maskers, I think it depends on the particular reason a person is anti-mask.
I'm working on the assumption that a lifelong smoker or someone who intentionally eschews safe-sex practices is generally aware of the risk they're courting. In my mind, this is "privatization of reward, socialization of risk" is similar to what we on HN often complain about regarding corporate bailouts.
In contrast, I could believe that at least some anti-maskers are genuinely misinformed about the risk posted by their behavior. I have less trouble feeling empathy for someone who's working from wrong beliefs, than someone who's knowingly being selfish.
You must be thinking about this in a weird way if you describe as selfish those people who have unsafe sex and contract HIV and who were fully aware of the risk. What do you think that they hoped to gain by becoming HIV positive? And if they thought it was an acceptable trade-in for some momentary pleasure, can they really have been fully informed in the first place? It seems that what you’re saying here is rooted in some kind of stereotype of crazy hedonism, rather than a more realistic understanding of the psychology of unsafe sex.
Believe me, there are idiots in all walks of life. There are plenty of people who are simply too dumb to practice safe sex, just as there are plenty of people too dumb to take trivial precautions against spreading COVID. I don’t think you’ll have much luck trying to formulate a coherent reason to regard the two groups in a fundamentally different light. Conservatives just have a bee in their collective bonnet about sex as compared to other comparably risky activities.
For some reason, any time there is any good news relating to HIV on HN, we have to have a thread where we seriously moot the question of whether HIV positive people deserve to die (or to put it in your bloodless terms, whether mercy is outweighed by justice). Have you considered just giving this a rest? Everyone already knows that many religious conservatives are in favor of denying treatment to HIV positive people belonging to social groups that they don’t like.
> Everyone already knows that many religious conservatives are in favor of denying treatment to HIV positive people belonging to social groups that they don’t like.
I'm sure there's malice, but I also get it. It's like --
Sometimes idiot hikers will set out into a wilderness with absolutely zero preparation, end up stranded in a life-threatening situation, and need to be helicoptered out of their plight for something like a million dollars of somebody else's money -- let's say the Park Service's.
No, I don't think they should be left to freeze to death, but if I'm funding the Park Service I have a right to be annoyed with them, especially if this isn't a one-off thing, but rather something that keeps happening.
In a world where antivirals cost a bajillion dollars, HIV can seem similar. "Get out of my risk pool."
But even from that perspective, this HIV vaccine is great. Give people the vaccine and now you aren't stuck paying for a lifelong prescription for Truvada or whatever else. Again, win-win.
Personally, when these vaccines get the kinks worked out, I will absolutely get them, even though I have zero intention of being at or of putting anyone at risk.
> It seems that what you’re saying here is rooted in some kind of stereotype of crazy hedonism, rather than a more realistic understanding of the psychology of unsafe sex.
If you delve into what has been written by radicals, you find all kinds of crazy shit, including the belief that STDs should be celebrated as a badge of courage. People as now-mainstream as Focault knowingly had unprotected sex, while HIV-positive, with anonymous men, wrapped it up (heh) in philosophical language, and sold it on to credulous academics. And there are other, slightly more fringe, characters whose names I forget; one guy I remember arguing that it was his political duty to "pos" people. To my ears this is batshit insanity and barely-disguised evil. Yet, though I know this thinking is not actually representative, it is often enough loudly defended (by trollish morons with no intention of living those values) for no reason other than that it's from "one of us". Conservatives are clearly reacting to that, in the age-old tradition of seeking out the worst crazy "the left" can provide.
> No, I don't think they should be left to freeze to death
Of course you don’t. But the OP would see this as a tricky ethical dilemma about balancing ‘mercy’ and ‘justice’. Or at least they should, if they’re not just selectively targeting groups of people that they don’t like.
> If you delve into what has been written by radicals, you find all kinds of crazy shit
You could say this about any group of people. No-one on this thread has defended any of these ‘radical’ ideas, and people have unprotected sex because they’re horny, not because Focault (who 99% of them have never heard of) told them to. So why are you even bringing any of this stuff up? It’s just muddying the waters.
> Yet, though I know this thinking is not actually representative, it is often enough loudly defended
No, deliberately giving people STDs is not an action that’s often loudly defended.
> No, deliberately giving people STDs is not an action that’s often loudly defended.
The action is not loudly defended, but the philosophy is. It's like when people from another part of the political landscape recommend "Industrial Society and its Future" but demur about the letter bombs.
> So why are you even bringing any of this stuff up? It’s just muddying the waters.
I was trying to explain the reaction. But, yeah, it's a waste of time. So here I stop.
There's an easy way to resolve that conflict that ought to appeal to religious conservatives: charity. If you donate to charities that help pay for people's HIV treatment, then no-one is being forced to pay and yet no-one is suffering unnecessarily either.
Oddly enough, despite being so deeply concerned with mercy and justice, religious conservatives do not appear to be among the leading donors to HIV-related charities.
That said, I don't see any kind of ethical dilemma here at all. It would clearly be a moral obscenity to systematically allow people to die of treatable diseases because they can't afford treatment. And if it's a question of 'blame' or 'risky behavior', then we should be refusing treatment to anyone who's ever eaten a donut.
> If you donate to charities that help pay for people's HIV treatment, then no-one is being forced to pay
If I feel you brought something on yourself why would I help you and not an innocent victim? And how would charity help resolve the issue of you dumping the cost on others, it would just be me instead of all of us, but still subsidizing.
> It would clearly be a moral obscenity to systematically allow people to die of treatable diseases because they can't afford treatment.
No, only if that money couldn't do greater good elsewhere.
> And if it's a question of 'blame' or 'risky behavior', then we should be refusing treatment to anyone who's ever eaten a donut.
In some proportion to the number of donuts, yes. Of course. Or at least they should go to the back of the line after we've helped people who didn't self-inflict.
I’m trying to look at this form the perspective of a religious conservative (presumably Christian, though I don’t know). “Only help others if you think they deserve it” is rather obviously not a precept that’s the basis of Christian charity. That is in fact why the OP says (quite despicably, in my view) that there is a conflict between justice and mercy in this case.
> how would charity help resolve the issue of you dumping the cost on others
OP objected to others being forced to pay. Charity is voluntary.
> Or at least they should go to the back of the line
What would this even mean in the case of the US. About 35% of adults are obese, and in almost all instances that’s due to their behavioral choices. Do we send a third of the population “to the back of the line”, or refuse to pay for their medical treatment?
I made my original post as an invitation to discuss my current views (which I admitted weren't settled). I was hoping to find any faults in my views' logic so I could replace them with something more logically consistent and, hopefully, loving.
The fact that you call my initial exposition "despicable" reminds me that HN isn't a good forum for this kind of discussion.
I regret posting a comment that elicited this kind of discussion.
Do you know of any first world countries where people are denied treatment for HIV depending on some assessment of whether or not it’s their fault that they’ve contracted it? E.g. we’ll pay for treatment if you get it from a blood transfusion but not if you get it sexually.
The proposal that you’re hinting at is very far outside the mainstream. I don’t think you’re likely to find any forum (that you’d want to be a part of) where it doesn’t elicit a strong negative reaction.
HN is probably one of few places that tolerates this kind of extremism enough to at least engage with your argument (such as it is) rather than just telling you to get stuffed.
> “Only help others if you think they deserve it” is rather obviously not a precept that’s the basis of Christian charity.
No, only help people if they didn't bring it on themselves and would probably be able to receive the help. There's no sense wasting a bunch of help on a junkie who won't use it, but once he's off the smack and willing to receive help then maybe. But only if a needy mother's kids don't need it more.
> Charity is voluntary.
Right, but you present it as an obligation. These people aren't being funded so you could just do it yourselves.
> About 35% of adults are obese, and in almost all instances that’s due to their behavioral choices. Do we send a third of the population “to the back of the line”, or refuse to pay for their medical treatment?
Oh boy, you're gonna hate this. Yes. And we already do. Try asking for an organ while you're a smoker. They give that sucker to someone who can use it and will take care of it.
What misguided sense of honor could force you to dispense treatment in the order people arrived in versus their need/ability to receive?
>No, only help people if they didn't bring it on themselves and would probably be able to receive the help.
You're suggesting that this is what Christianity has to say on the subject of charity?
>Right, but you present [charity] as an obligation.
No, I didn't. I pointed out that voluntary charitable contributions would be a good way to resolve the tension that the OP feels between 'justice' and 'mercy'.
>Oh boy, you're gonna hate this. Yes. And we already do.
In the case of organs there's an inherently limited supply, since people have to donate voluntarily and all sorts of other conditions have to be met. It's not as if we're throwing away livers rather than give them to alcoholics.
I'm sure you must be aware that we do treat all kinds of obesity-related conditions – and at great expense. In the case of HIV treatment, it's largely just a question of paying for drugs which can easily be manufactured in the required quantity.
But I guess at this point I'm wondering what your actual position is. Are you in favor of conditionally refusing treatment to HIV patients depending on the manner in which they contracted the virus? If so, why not just come out and say it? And if not, what exactly are you getting at?
> In the case of organs there's an inherently limited supply, since people have to donate voluntarily and all sorts of other conditions have to be met.
Yes, and charity spending on one person necessarily takes away from spending on another too. To support someone whose choice of behavior impacted them means you can't support someone who was injured entirely through 'acts of god'.
> It's not as if we're throwing away livers rather than give them to alcoholics.
No, but but they do go to the back of the line. Especially if they still drink.
> I'm sure you must be aware that we do treat all kinds of obesity-related conditions – and at great expense.
Sure. But thankfully we prioritize them to below children with heart defects, and non-obese adults with the same conditions.
> Are you in favor of conditionally refusing treatment to HIV patients depending on the manner in which they contracted the virus?
No more than I am for prioritizing treatment downward for everyone whose injuries were self-inflicted. That's only fair for the people whose were not.
I don't think you've really answered the last question. At the moment, in the US, how you contracted HIV makes no difference to your access to treatment. Do you think this should change or not?
As to the rest, you're obviously aware that in general, obese adults are not deprioritized for treatment as compared to non-obese adults.
> I don't think you've really answered the last question
That's pretty much a textbook example of sealioning. Why are you so anxious?
> HIV
Are they asking for charity? If not then their circumstances shouldn't be relevant, just their ability to pay.
> you're obviously aware that in general, obese adults are not deprioritized for treatment as compared to non-obese adults.
They are. If you're up for a contested treatment (a rare organ, a diagnostic machine that's always in use) you're given a score that represents your health and ability to benefit. Obesity isn't a total black mark but it absolutely is considered. However, we don't consider why you're fat, fat is just a health risk and we recognize that and don't waste effort where it won't be rewarded.
It seems you agree, then, that there is no ethical dilemma in insurers paying for HIV treatment regardless of whether the patient acted irresponsibly. But it would be easier to understand your answer if you’d just say whether or not you think that access to HIV treatment in the US should be more restrictive than it is at present.
We already covered the special case of contested treatments. It’s obviously irrelevant here as we are just talking about access to drugs for HIV patients, not access to an inherently limited resource. Either you pay for Truvda or you don’t. There’s no queue.
Similarly, if you are obese, no generally available treatment that could be of medical benefit to you will be denied merely because it’s expensive and you’re obese.
> Similarly, if you are obese, no generally available treatment that could be of medical benefit to you will be denied merely because it’s expensive and you’re obese.
Nope. There's a limit to everyone's insurance, beyond which they will not pay for more treatment. You won't get told that you're too fat but your treatments will cost more and consequently you'll get less of them. Your insurance contract is for a sum of money, not a specific set of life-saving actions.
But generally that limit is much higher than what you've paid so your expensive treatments take money from the pool.
> there is no ethical dilemma in insurers paying for HIV treatment regardless of whether the patient acted irresponsibly.
As long as their fees cover the payments. But if they're costing more than they're paying as a class, meaning that all other users are compensating them, then yes - dilemma.
> It’s obviously irrelevant here as we are just talking about access to drugs for HIV patients, not access to an inherently limited resource. Either you pay for Truvda or you don’t. There’s no queue.
Paying out of your own pocket, 100% fine regardless.
Just in case it adds clarification. I think the downvotes are due to equating HIV to justice. Smoking once it is well understood I guess kinda is, but HIV is really just a matter of luck like all infectious diseases. You can reduce your risk (eg masks for stopping flu or COVID), but to call it “justice” feels very callous to me.
Thanks for that. It sounds like I did a terrible job of expressing my thoughts.
Perhaps one of my mistakes was using HIV as an example. If someone only skimmed my post, they may have pattern-matched on the whole "AIDS is punishment from God" trope, which is 100% not what I was trying to say.
"religious conservatives do not appear to be among the leading donors to HIV-related charities."
Cite your sources please, because I've seen the opposite in my (limited) charity dealings.
Wow, this is the worst misinterpretation of conservatism I've seen... (let's say 'today')
Sex isn't wrong. It just so happens that it can lead to HIV infection. If you wish people get infected, you've created a moral loop that just punishes people because you enjoy watching people suffer. Congratulations, maybe you do have a handle of conservatism-as-practiced, after all.
It'd make just as much sense to threaten to kill anyone found in public without a blue towel: you'd get the satisfaction of righteousness indignation and the honour of killing lots of people for completely arbitrary reasons.
Many who are 'sexually active' are also unwillingly so. By that criteria, it would be best to recommended it to all women and all prisoners in the United States, due to how common rape is among those populations here. I'd like to say "we are better as a society" but that's not true yet, and in the meantime, at least I won't have to worry about AIDS when it's my turn to be raped.
I was considering the penetration category statistics alone, which was at least once in their life for 18.3% of all women in the country: https://www.nsvrc.org/statistics
Since one time is all it takes to get HIV, that's 18.3% of the female population that are vulnerable to infection from an attacker at some point in their life. Best to get vaccinated and not take that risk.
Unwanted sex occurs so frequently in the US that, as I said above, "sexually active" essentially includes all women and all prisoners, in the context of this conversation about which populations should receive this vaccine.
This is not the place to litigate over statistics provided by NSVRC. This is not the place to debate whether the women were intoxicated or not. This is not the place to debate whether all rape is truly rape or is not. Whether you label it rape or label it unwanted sex or label it unplanned intoxicated sex is irrelevant.
I'd look at the definitions closely, especially for what counts as rape by intoxication. What ordinary women think of as too drunk to consent and what sexual assault activists think is very different.
I feel confident enough that I don't have to look this up, but I might be wrong. Most women in the US surely aren't raped right? Not even 0.1% of women in the US get raped no? So I don't think you need to forcibly vaccinate people because of any rape risks.
Most people who are sexually active are voluntary so, so let's just assume people are not talking about sexual assault when talking about an active sex life.
> Most women in the US surely aren't raped right? Not even 0.1% of women in the US get raped no?
You’re presumption is so bad it’s not even wrong.
> “Nearly 1 in 5 women (18.3%) and 1 in 71 men (1.4%) in the United States have been raped at some time in their lives, including completed forced penetration, attempted forced penetration, or alcohol/drug facilitated completed penetration. [0]
If you look up the history of the HPV vaccine and how a subset of the United States decided that it wasn't acceptable to protect women from cervical cancer because 'reasons', you can start to get a sense of the kind of uphill battle an HIV vaccine will face. It's hard enough to explain to parents that it doesn't matter if their kid is sexually active for HPV, imagine how much worse it's going to be when they add "10% of girls will be raped before they turn 18" to the mix.
So rape ends up being epidemiologically-relevant to STD vaccines, but there's a lot of folks who would rather not confront that — even here on HN.
Irrelevant. If I successfully defend myself from a rape attempt by biting the attacker, that will be recorded as "attempted", and yet I will still be exposed to the risk of HIV infection.
I guess that’s the question: does “attempted rape” really expose one to risk of HIV infection? What fraction of attempted rape victims go on to contract HIV compared to those who were actually raped? What gets counted as “attempted rape”? If the victim escapes before anyone’s clothes are off, does that get recorded as attempted rape? Presumably in that scenario omens risk of contracting HIV isn’t meaningfully increased?
If the rapist spits on them, maybe. If the person being raped bites them in self-defense, maybe. If the rapist is wounded and bleeds on them (and others!), maybe. The statistic you seek is "unsuccessful rape attempts that did not result in fluid transfer risk to the person being raped, bystanders, or emergency responders". If you are able to find it, feel free to link it here. I suspect you will find that no such data is collected.
Fortunately, this is irrelevant. Given the severity of HIV, the full 18% figure can be safely taken at face value, for society-level disease prevention purposes. HIV is both expensive and deadly and vaccination is cheap.
As with any vaccine the ideal outcome is the general population is vaccinated and we develop a herd immunity. For a deadly disease like HIV spending the effort to eradicate the disease would be for the best, but like HPV vaccination there's a moral judgment tied to it that will prevent some people from accepting everyone should be vaccinated.
As a side note, it was ridiculous that it took so long for boys to start getting the HPV vaccine. If you're a public health person, even if your only concern is cancer in women, you still want to vaccinate boys to improve herd immunity. If you're a heterosexual man, even if you only care about cancer in women, you would like to have been vaccinated if you are a remotely decent person, because you don't want to give women cancer -- especially the women you have sex with, who, generally, are going to be people you care about. And additionally there are male health concerns related to HPV -- for heterosexuals, primarily oral cancer, and for homosexuals, possibly also anal cancer (these being generalizations, of course). These are nasty, lethal diseases. Surely they should be prevented as well? Given the multitude of common-sense reasons to do it, for the benefit of so many people, it was frustrating to watch it happen only with such a long delay.
Much of the opposition seemed to come from a vengeful kind of religious conservative who wants sex to have negative consequences. Those conservatives represent a familiar kind of evil.
Yet I suspect that some opposition also came from women who had a problem with protecting men's sexual health. This is a newer kind of evil, and even less sensible for women who are heterosexual, for the herd-immunity reasons I outlined in my first paragraph.
A more-widely-administered HPV vaccine was literally a win-win for everyone, gay and straight, female and male, and still it came about slowly and faced opposition. This made me despair of my fellow humans.
You're right, and I've added some defensive language, but please don't get distracted from the main point, which is that we had an opportunity to reduce the spread of a contagious cancer in people of all sexes, genders, and orientations, and yet we got into stupid fights instead of doing it quickly.
Don't religious people claim that limiting your sex activity to one single person is the best way to prevent diseases at large scale?
[obviously denying the frustration and alienation that goes with it]
But sure, that works when people do it. Just like social distancing.
Relying on other people's good behavior at a large scale is a bad plan though.
Also not sure which number of partners brings the most frustration or alienation. One? Three? Zero? Each situation seems to bring its own problems. Life is suffering.
("One" is the best plan for most people, but it depends a lot on which one...)
The public health community learned a hard lesson from this mentality with the HPV vaccine. Many young girls did not get the vaccine because they (or their parents) insisted they were not and would not be sexually active. The CDC recommendations for who should get the vaccine (which controls whether insurance covers it and whether military members are eligible to receive it) expanded from young girls to all people under 27, then to all people under 45.
Regarding HIV, why not get vaccinated if you have easy access to it? What is the harm in being immune to HIV?
OP asks about what's required, not what makes sense. Everyone needs to be required to get vaccines like measles and Covid because the vaccine doesn't work on everyone so we need herd immunity to ensure safety. HIV does not require herd immunity in the same way as there is no way to get it if you are in a monogamous relationship/not sexually active and don't share needles. Therefore the vaccine isn't required to ensure the safety of everyone that desires it.
> ...there is no way to get it if you are in a monogamous relationship...
People are frequently unfaithful without their partner's knowledge. Healthcare workers/Dentists are at an elevated risk of infection, and by association so are their partners. As are law enforcement, and their partners. If you routinely interact with the homeless professionally or as a volunteer, you're at an elevated risk.
This is the same mentality that was so tragically wrong and disproven by the data numerous times, no? Girls grow up and eventually have sex, right? Sex is a very human thing, and proclamations about monogamy or abstinence tend to be more religious/cultural signaling than reflections of people's actual behavior or the real need for people to get vaccinated.
They developed a piece of mRNA that produces a specific type of blood protein that binds the HIV infection mechanism. The bound protein triggers your body’s antibody cascade to attack and neutralize it.
It's really interesting stuff. One issue as I understand it is getting the immune reaction to be appropriate to develop antibodies without going crazy.
From TFA to set context: The vaccine is an immune primer, to trigger the activation of naive B cells via a process called germline-targeting, as the first stage in a multi-step vaccine regimen to elicit the production of many different types of broadly neutralizing antibodies (bnAbs). Stimulating the production of bnAbs has been pursued as a holy grail in HIV for decades.
That is, the vaccine triggers generation of bnAbs successfully, turning a "passive immunization" HIV/AIDS treatment in to "active immunization".
More on bnAbs:
> Antibodies are proteins that immune cells make to block viruses and other infectious agents. In the case of HIV, people who are infected typically produce antibodies to the virus. But because the virus mutates and replicates rapidly, antibodies are largely ineffective at controlling the virus. After years of infection, though, some people produce highly potent antibodies called broadly neutralizing antibodies (bnAbs) that, in laboratory tests, are able to neutralize a wide variety of HIV strains. The identification of such antibodies has transformed the field of HIV prevention research for two reasons: it provides information to guide the design of vaccines that could elicit bnAbs for protection, and it has opened the door to a new prevention modality: the administration of HIV bnAbs to prevent infection.
> The administration of antibodies to prevent infection is known as passive immunization, in contrast to active immunization, which occurs as a result of vaccination (see graphic, below). While a vaccine “trains” the immune system to generate antibodies and other immune responses, passive immunization requires that the antibodies be delivered directly into the body through infusions or injections. This protection is temporary, and, in the case of HIV prevention, would need to be administered periodically as long as the subject was still at risk.
You can keep it from spreading quickly within a person's body, and reduce the chances of transmission, if you can reduce the amount of viral particles that exist outside of host cells.
Like previously stated, HIV hides inside of cells for an indeterminate amount of time. As you mentioned immune memory can take a little bit of time to kick in. Once it kicks in however, it is extraordinarily effective at hunting down viruses and actively (non-dormant) infected cells. With a small enough viral load however, the immune system can fend off HIV well enough.
During an initial infection either the immune system will fight off the virus if the load is small enough and it gets lucky or the virus takes hold of some cells and starts reproducing. In this latter case, the immune memory allows the immune system to effectively fight off the virus before it can properly take hold. Of course some of the virus may lay dormant in a few cells but since it never gets a chance to take hold of the body the quantity of dormant infected cells is relatively low.
Now due to the low quantity of dormant infected cells, it is extremely unlikely that there will be enough "activated" cells at any given time that the immune system is not able to handle the threat before it escalates. Over time you can expect the dormant HIV to slowly be exterminated or at very least prevented from growing in count.
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Now this isn't anything terribly new. The real breakthrough with this vaccine over other attempts in the past is that it results in the production of a specific type of antibody that can act on all known HIV strains with essentially the same efficacy (where as prior vaccines couldn't result in the production of antibodies that worked reliably on even small portions of the thousands of different HIV strains).
>Right but for a virus that integrates into the genome once it takes hold it's game over.
The same could be said about any other successful vaccine, like Polio and Measles vaccines. Not that those diseases behave like HIV, but the way we handle vaccination against them.
>And even vaccine mediated immune responses are via memory cells and take time to ramp up to generate the antibodies to attack the virus.
That's why there are vaccination campaigns, to immunize target groups before they contract the aforementioned sickness.
>Is the window of opportunity while ramping up the immune system for a vaccine I mean unresponse big enough for HIV to take root in a body.
A vaccine is always a good opportunity to prevent adverse effects, even "if takes time" to ramp up your immune system.
We've had to warn you before about breaking the site guidelines. Attacking another user like that will get you banned here.
If another comment contains incorrect information, the thing to do is share correct information, so we all can learn. Breaking the site guidelines and lashing out with putdowns just makes the thread even worse.
HIV does not generally infect the germ cells that produce sperm or eggs, so it is not heritable, which is maybe the sense you interpreted OP's comment.
Still, HIV is a provirus. Retroviruses write themselves into the genome of the host cell. Cells which are infected and survive to reproduce carry the HIV provirus. As will their descendants, and so on. They will produce HIV when mature even without any HIV particles in the cell. This is integration with the host genome.
This is why HIV cannot be cured with antivirals which fully inhibit its replication. It's also why complete destruction of the immune system (in the process destroying all the cells which are the specific hosts) while flooding the body with high dose antivirals, and then grafting innately immune T-cells, is an effective, if rather drastic, cure.
I don't know much about it, but, from my understanding, HIV is a "retrovirus", which means that it integrates into host cell's DNA: https://en.wikipedia.org/wiki/Retrovirus
I'd really appreciate some input from someone who knows more on this topic.
After entering a CD4+ cell, HIV uses reverse transcriptase to copy it's RNA into DNA, enters the cell's nucleus, then uses integrase to splice that DNA into the host cell's genome. From that point on the host cell is permanently infected. This is one of the few exceptions to the "central dogma of molecular biology", which otherwise says information can't flow back into the nucleus.
The reverse transcription process is notoriously error prone, which is the reason why HIV is able to mutate so easily and develop resistance to antiviral drugs.
Most cells will go on to immediately begin building new HIV copies; these cells will quickly die out. A small number will go back to a resting state, only to reactivate months or years later. This "latent reservoir" of dormant cells means that even if you eradicate all the viremia from a patient, the infection will come back. This is why we can't cure HIV.
There is a very small window after infection before the virus has had a chance to establish a latent resevior where it can be successfully eradicated. This is how prophylactic drugs as part of PEP can work - if given quickly enough.
There's a really good animation someone posted here a few days ago that illustrates the mechanics: https://vimeo.com/260291607
Thank you. And it uses the enzyme integrase to integrate into the host cells genome and reverse transcriptase to create DNA from RNA.
Anyone who has looked into any science beyond what the media talks about knows this about HIV.
What's even more interesting is that there's latent reservoirs in a person's body that we don't know where they are so that even after we get someone's viral count undetectable with meds, if they stop the medicine hov can come back
Does every Dunning Kruger moron on the planet just talk with authority about science now because they posted the hashtag #believeInScience during Coronavirus?
The numb skulls in this thread need to gooogle retrovirus, integrase, and reverse transcriptase before even typing or better yet even thinking they know anything about biology just because they know how to write a JavaScript component.
Breaking the site guidelines like this will get you banned here regardless of how much you know or how right you are. The destruction it causes to the community is not worth it.
We've had to warn you more than once about this kind of thing before. Not cool.
I replied to that user too, but even if I hadn't, pointing the finger at someone else is not a good way to respond to your own breaking of the rules, and certainly doesn't justify anything. Everyone here needs to follow the rules regardless of what the other person does. Otherwise we just get a downward spiral.
I hear you. I mean I think that's everyone's instinct.
The problem on the internet is that we all have a tendency to overestimate the other person's rudeness and underestimate our own, so we all come into these conflicts feeling like the aggrieved one. When both parties feel that way, the discussion can only degenerate.
We've been down this path before with vaccines. Often what seems promising early on doesn't pan out long-term.
This is why clinical trials are so lengthy. You have to operate at the time-constants of biology and the human body rather than political or business time-constants. The former are far longer than the latter.
BTW if you get a COVID vaccine right now, you are literally a clinical trial subject/participant. COVID vaccine clinical trials do not end until 2023 in the US based on FDA documents.
Clinical trials for vaccines take a while because we don't intentionally infect people and it takes a long time for the test population to naturally catch whatever it is.
They went fast for COVID because it's a pandemic and everyone was getting it.
As far as I can tell, what's going on here is that there are multiple stages of antibody development. People have circulating B cells, and these cells have their genomes modified by the the VD(J) recombination process [0] from the genome in the human germline (i.e. what your germline cells and most of the non-B cells in your body have). There are a large number, but nowhere near infinite number, of B cells and corresponding antibodies that can be produced in this process, and I think these are what the authors call "germline" cells.
Once a naive B cell decides that it encodes a useful antibody (which is a complicated process), it starts to divide. Some of the daughter cells further mutate in a process called affinity maturation [1] to produce what are hopefully even better antibodies.
I think that the idea behind this research is that there are certain antibodies that can be produced by affinity maturation that are very useful against HIV, but that the "germline" B cells that lead to these antibodies are not particularly likely to be selected by the immune system when exposed to natural HIV antigens. Instead, the researchers have developed customized antigens intended to target specific germline cells which are known to be able to mature into cells that can produce the desired antibodies. If this works, the next step would be a series of additional vaccines (which are not the same as dose 1) that will try to encourage maturation into the useful antibodies.
The takeaway is that this result is very promising and that there is (so far?) no reason to expect the trial participants to be immune to HIV.
For the ML crowd, another way to think about this is that, when your body is exposed to an antigen, it runs a massively parallel search algorithm to find good antibodies in a truly massive space of possible antibodies. Unfortunately, most people, when exposed to real HIV or to prior vaccine attempts, get stuck in a bunch of not-fantastic local minima. The idea is to specifically aim the search in the right direction so, after a few rounds, it can find a better solution.
[0] https://en.wikipedia.org/wiki/V(D)J_recombination
[1] https://en.wikipedia.org/wiki/Affinity_maturation