PrEP approved by a wide margin. Now, what about those ADAP waiting lists? #HIV #AIDS
I’ve been a big advocate of PrEP and Gilead’s Truvada as a preventative course of action. Any solution to me that reduces the number of infections is a good one. A few days ago, the FDA approved Truvada by a huge margin:
The US Food and Drug Administration (FDA) took a decisive step yesterday towards approving the use of combination pill Truvada (tenofovir/FTC) as a prevention method for HIV-negative people.
The FDA’s Antiviral Drugs Advisory Committee (ADAC) voted by a majority of 19 to 3 in favour of recommending Truvada as PrEP (pre-exposure prophylaxis) for men who have sex with men, and by 19 to 2 with one abstention for an approval for use by the HIV-negative partner in serodiscordant couples.
There was a closer vote, however, when it came to recommending its use generally in individuals for people at risk of HIV infection: 12 to 8, with two abstentions, voted for a general recommendation for any person at risk of HIV.
The ADAC decision was taken after an all-day meeting on 10 May. This meeting discussed the findings of a written report and also heard submissions from a large number of community prevention and treatment advocates. Interest was such that the FDA extended the time for submissions from advocates and community members from one hour to two and had to organise a ballot for access to the hearings.
The written report had concluded that concerns about safety and HIV drug resistance were not sufficient to delay the introduction of PrEP. It also decided that concerns about poor adherence levels seen in some randomised controlled trials, and about whether PrEP would negatively influence behaviour to such a degree that people ended up at greater risk of HIV, were beyond the remit of the FDA.
“I don’t think it’s our charge to judge whether people will take the medicine,” panellist Dr Tom Giordano told the Los Angeles Times. “Our charge is to judge whether it works when taken.”
Considerations of cost are also explicitly ruled out of the FDA’s remit when it comes to approving a new drug or indication.
At the May hearing, an FDA Advisory Committee will consider data from a wide range of safety and efficacy studies, including two pivotal clinical trials of TDF/FTC as PrEP:
- The Partners PrEP trial, which found that daily TDF/FTC reduced HIV infections by 73 percent among heterosexual couples in Africa in which one partner was HIV infected and the other was not. Efficacy was 90 percent among those who adhered closely to their daily drug regimen.
- An international study called iPrEx found that daily use of the drugs reduced HIV infections by 42 percent among MSM, and by more than 90 percent among participants who took their medication consistently enough for the drug to be detected in their blood.
These studies demonstrate that PrEP was safe, with minimal side effects and no significant risk of drug resistance. These and other trials also indicate that effectiveness of TDF/FTC as PrEP depends greatly on individuals’ adherence to the PrEP regimen. In each trial, when adherence was low, there was low or no protection, pointing to the central importance of strategies to maximize adherence.
“If FDA approves PrEP, we’ll still have a lot of work to do, just as with any other new drug. We’ll have many questions to answer in order to use PrEP effectively to reduce HIV infections,” said David Munar, President and CEO of the AIDS Foundation ofChicago. “The essential next step will be to launch additional demonstration projects in a wide range of populations and settings. These real-world projects will help us understand how to achieve higher levels of adherence, how to best combine PrEP with other approaches, and which specific populations can benefit the most. While a handful of these real-world studies are now being planned, we need to pick up the pace.”
Now, not to throw ants on anyone’s picnic, but lets level the scale for a moment. I’m betting that Truvada makes it’s way through approvals and presto! The price falls through the floor. What’s estimated to about $35 dollars a day per dose
(that link is a bit old, but you’ll get the idea) is no doubt going to get cheap. Real cheap. What’s the point of Gilead pushing getting a drug approved that no one can afford, and no insurance plan will cover?
None. It’s business suicide and they know it. Once the approvals process is over I’m going to wager that Truvada is far more accessible than it is currently.
Now – what about those ADAP waiting lists? Hmmm? It’s great that Truvada is on it’s way to becoming a prevention enhancement for people, but what about those who are HIV positive and can’t afford their medications?
HIV doesn’t hit a pause button.