There’s good news on the pre-exposure prophylaxis (PrEP) front! Not that PrEP alone isn’t great news. After all, what’s not to love about a daily medicine (Truvada®) that reduces the risk of getting HIV from sex by more than 90 percent? (Among people who inject drugs, it reduces risk by more than 70 percent.) Combined with condoms (“PrEP + 1”), your risk of getting HIV from sex can be lowered even further.
So—the current good news: soon, more people may be able to afford the drug—which is important, given it has an annual price tag (before discounts provided to insurers) of about $21,000. Although many insurers cover the drug, it may carry a high enough co-pay that potential users cannot access it. What happened to improve that situation?
In June 2019, the US Preventive Services Task Force recommended that physicians offer PrEP to people at high risk of contracting human immunodeficiency virus (HIV). Recommendations made by the task force have implications for health insurers: As a result of this recommendation, starting in 2021, most health plans will be required to cover drugs recommended to prevent HIV, and patients cannot be charged anything out-of-pocket for the medication.
This could result in a real uptick in the number of people taking the drug. And that would be a very good thing: The Centers for Disease Control and Prevention (CDC) has estimated that 1.1 million people in the US could benefit from taking Truvada. Gilead, the biotechnology company which developed and holds the patent on Truvada, reported that during the second quarter of 2019 about 213,000 people were taking the drug for HIV prevention. That means that just under 20 percent of those people who could benefit are actually taking the drug. Clearly, there’s room for improvement.
There’s more good news, too: A generic version of Truvada is scheduled to be available in the US in September 2020, with more generic versions expected in 2021. Often, the availability of generic versions of drugs drives prices down.
Of course, some barriers to access remain: Truvada is available only by prescription, and requires both pre-prescribing laboratory testing and quarterly laboratory monitoring. Typically, obtaining orders for that testing—as well as prescriptions for Truvada—require physician (or clinic) office visits. The costs of both office visits and laboratory testing may—or may not—be covered by insurance.
In related news: Gilead hopes soon to be marketing a newer drug, Descovy, for HIV prevention. (The drug was approved in 2016 for treating people who already have HIV.) In early August, a US Food and Drug Administration (FDA) advisory panel recommended the agency approve the drug for prevention purposes. Descovy has been shown in clinical trials to be less toxic to the bones and kidneys than Truvada. At least for patients whose bones or kidneys are deemed to be at risk from Truvada, Descovy may provide an alternative.
Interested in learning more or in talking with a health care provider about PrEP? CAMP Rehoboth can help!
Contact Health & Wellness Director Salvatore Seeley (302-227-5620) to talk about what’s available and how to connect with resources. We offer HIV (and other STI) testing, and referrals to LGBTQ-friendly health care navigators who are familiar with PrEP. These individuals can prescribe PrEP and the periodic lab testing its use requires, and can even help you find resources to pay for the drug if your insurer does not cover it.
More News on the Prevention Front
On June 26 of this year, a CDC advisory committee recommended that adults age 27 to 45 who have not been vaccinated against human papilloma virus (HPV) should receive the vaccine. Why is that important? Because infection from HPV, which is a group of more than 100 related viruses, is a major risk factor for six types of cancer.
HPV causes cancer in both women and men, with about 60 percent of these cancers occurring among women. The six cancers are: cervical, vaginal, and vulvar cancers; penile cancer; and anal and back-of-the-throat cancers.
Cancer of the cervix is the most common HPV-related cancer among women, accounting for just over half (53 percent) of the 20,300 HPV-related cancer cases reported among women as of August 2018. Vulvar and vaginal cancers accounted for 16 percent; anal cancer for 20 percent; and back-of-the-throat cancer for 11 percent.
Back-of-the-throat cancer is the most common HPV-related cancer among men, accounting for 80 percent of the 13,400 HPV-related cancer cases reported among men as of August 2018. Anal cancer accounted for 14 percent, and penile cancer for 6 percent.
So—where’s the good news in all that?! Right here: These HPV-related cancers are largely preventable! And not by something really unappealing like, say, abstinence.
They are prevented by that aforementioned vaccination. There is a two-dose series for children who are 11 or 12 years of age (or younger) when they receive the first dose; the second dose is given six to 12 months later. For people who start the series at age 15 or older, there is a three-dose series given over a period of six months.
Vaccination is recommended for:
→ Girls and boys 11 or 12 years of age (or as young as nine).
→ Females age 13-26 years of age and males 13-21 years of age who have not started the vaccines or who started—but did not complete—the series. Males age 22-26 years can also be vaccinated.
→ Men who have sex with men (through 26 years of age).
→ People with weakened immune systems, including those with HIV, if they have not previously been vaccinated.
→ Young adults who are transgender.
→ And now, also for people 27 to 45 years of age who have not previously been vaccinated.
Since their introduction, the vaccines have proven their effectiveness. For example, among teen girls, infections with HPV types that cause most HPV cancers have dropped 71 percent; among young adult women, these rates of infection have dropped 61 percent.
Fall into one of the groups recommended for vaccination? Talk to your health care provider! And if you don’t—maybe you have a child or grandchild or other family member or friend who does. Talk to them. Make sure they’re aware the vaccine is readily available—and can be a real life-saver. ▼
Is PrEP right for you?
The Centers for Disease Control and Prevention (CDC) says it might be, if you fit into any of the below categories:
You are HIV negative AND you are a gay or bisexual man who:
Has an HIV-positive partner or Has multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown—and you also: Have anal sex without a condom, or Recently had a sexually transmitted infection (STI).
You are HIV negative AND a heterosexual (man or woman) who:
Has an HIV-positive partner; or Has multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown—and you also: Don’t always use a condom for sex with people who inject drugs or Don’t always use a condom for sex with bisexual men.
You are HIV negative AND you inject drugs AND you:
Share needles or equipment to inject drugs; Recently went to a drug treatment program; or Are at risk for getting HIV from sex.
Marj is an epidemiologist and wordsmith who has devoted her life to minutiae. She reports that yes, the devils are in the details. Aren’t they always?