Despite advances in genetic engineering, mRNA vaccine technologies, and precision medicine, some diseases continue to pose serious health threats. HIV, and AIDS in particular, represents one of these conditions, especially in low-to-middle income countries. Over the years, improvements have occurred with several HIV research breakthroughs, and opportunities to prevent high-risk individuals from contracted the virus now exist through various pills and even injections. But these advances have yet to be effective in significantly reducing HIV occurrence in places like South Africa. Access, high costs of care, and stigma continue to undermine efforts. That could change in the near future.
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The new anti-HIV prevention treatment involves an injection that only needs to be administered twice each year. While this offers the chance for mush better compliance to care, its degree of effectiveness is believed to be even more impressive. In fact, the study conducted among young African women as stopped because of its positive benefits. No cases of HIV developed among this population over several months of testing. And compared to other existing anti-HIV prevent treatment options, it looked to be far superior. Now the question is how to improve access to effective HIV treatment in African and similar regions. This continues to be a challenging problem, but this could be the last major issue to address in efforts to eradicate HIV worldwide.
The Latest Anti-HIV Prevention Treatment
The most recent drug trial testing a new anti-HIV prevention treatment was conducted under the name “Purpose 1.” Sponsored by the Advocacy for Prevention of HIV and AIDS in Sout Africa, the randomized controlled trial involved thousands of women. Over 2,000 received a new injection developed by Gilead Sciences called lenacapavir. In addition, two other groups of over 1,000 women received one of two oral tablet prevention options. To date, these tablets have been the only access to effective HIV treatment. Therefore, these two groups represented current standards of care. But after only a few months, marked discrepancies between the groups were noted. While both the oral tablet groups had new positive HIV cases, the lenacapavir group had none. As a result, the independent review committee halted the study so all participants could receive the injection.
In recent years, several studies examining anti-HIV prevention treatment have been performed. But the current study involving lenacapavir is unique due to its participants. In most HIV drug studies, men having sex with men tend to be the primary population. However, in the Gilead study, women were the main focus with the average age between 16 and 25 years. This age group, and gender, represent the highest risk group in South Africa. Therefore, the study is highly relevant to this region and other low-income countries where HIV is prevalent. In addition, both pregnant and lactating women were included as well, which is also uncommon in other research. Thus, the study offers tremendous promise not only because of its results but because of the population that was included.
Dealing with Access to Effective HIV Treatment
While the news regarding this new anti-HIV prevention treatment is exciting, there are some major caveats. The biggest involves the new drug’s price tag. Gilead charges around $42,250 per patient per year for the two required injections. Notably, this is well beyond any feasible price that would allow reasonable access to effective HIV treatment. However, Gilead has promised to allow generic manufacturers to make the drug at lower rates. Intellectual property rights will be released to these producers in exchange for a licensing agreement. Generally, it could take two years before these generic versions might be ready, so Gilead has vowed to fill this void to low-income regions like South Africa in the meantime. However, it has yet to be announced the amount and the cost reductions that Gilead will offer.
Access to effective HIV treatment in South Africa in particular has been an ongoing problem. The current anti-HIV prevention treatment options there involve two different pills. One is Truvada and the other is Descovy. Both must be taken daily, which often undermines adherence. Plus, since South Africa’s budget for this treatment is only $40 per person per year, many don’t receive these options. In addition, there is another anti-HIV prevention treatment injection called cabotegravir that is give every other month. It too has shown good effectiveness. But despite price reductions by pharmaceutical maker ViiV Healthcare, cost remains excessive. The current price of this drug at $180 per person per year makes general access to effective HIV treatment out-of-reach. Thus, access looks to be a continued dilemma for low-income regions dealing with HIV.
A Brighter Future Ahead?
Without question, the recent study out of South Africa is both exciting and promising. An anti-HIV prevention treatment that may completely protect high-risk populations would be welcomed everywhere. This is especially true since efforts in HIV vaccine research have yet to identify an effective treatment. Currently, there are over 23 million people living with HIV in the Sub-Saharan regions of Africa. Women may up 58% of these individuals, and most are in their youth. In addition to impoverished conditions, these same women experience stigma related to taking HIV drugs. And lack of transportation often negatively affects their access to effective HIV treatment. From this perspective, the new injection treatment could have profound impacts if cost barriers can be worked out.
It should be recognized that despite having a large number of participants, the study has not yet been peer-reviewed. That means experts in HIV and AIDS need to review the randomized controlled trial to determine its level of quality and value. But assuming the results are valid, it would appear that Gilead Sciences has identified a potential winner for HIV prevention. Ultimately, that could mean that the world could actually see HIV fade away completely in decades to come. And that is certainly reason to celebrate this study’s findings.
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