Two PrEP drugs are actually accessible. Equally secure/efficient. The most important distinction? The value tag.

Two PrEP drugs are actually accessible. Equally secure/efficient. The most important distinction? The value tag.

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With a considerably costlier medicine for HIV preexposure prophylaxis (PrEP) accredited in 2019, a brand new examine examined causes sufferers switched to the brand new drug. Examine outcomes point out {that a} minority of those that switched had a documented medical cause to take action.

The examine was led by researchers at Harvard Medical College, Harvard Pilgrim Well being Care Institute, and The Fenway Institute, and seems on-line on August 5 as an Editor’s Selection article in Open Discussion board Infectious Ailments.

PrEP is an antiretroviral capsule that’s 99% efficient in stopping HIV acquisition when taken as prescribed. It’s accessible in two varieties: co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC, or Truvada) and the newer tenofovir alafenamide with emtricitabine (TAF/FTC, or Descovy). TAF/FTC was accredited by the FDA in 2019 for stopping sexual transmission of HIV, apart from individuals in danger by way of receptive vaginal intercourse.

Each PrEP drugs are extremely efficient and intensely secure. TDF/FTC has been related to small decreases in renal operate and bone mineral density, and TAF/FTC has been related to minor weight acquire and dyslipidemia, however these incremental variations haven’t translated to variations in antagonistic medical occasions.

The drugs differ considerably, nonetheless, with regards to value: generic TDF/FTC turned accessible within the U.S. in October 2020, and now prices as little as $30 monthly, in contrast with about $1800 monthly for branded TAF/FTC.

“One of the vital vital obstacles to broad and equitable PrEP use within the U.S. has been value, together with each perceived and precise prices,” mentioned lead creator Julia Marcus, Ph.D., Affiliate Professor within the Division of Inhabitants Medication at Harvard Medical College and Harvard Pilgrim Well being Care Institute. “Generic TDF/FTC may revolutionize PrEP entry, however that chance can be missed if sources are invested in a much more costly medicine with out proportional enhancements in medical outcomes.”

The researchers extracted digital well being report information from 2,892 adults who had been assigned male intercourse at delivery, had been prescribed TDF/FTC for PrEP within the 12 months earlier than FDA approval of TAF/FTC, and had not less than one PrEP prescription within the following 12 months. All sufferers had been seen at Fenway Well being, a Boston group well being heart that focuses on take care of sexual and gender minorities.

The crew evaluated what number of PrEP customers switched to TAF/FTC and whether or not sufferers had a medical indication for switching. They discovered that 11.9% of the examine inhabitants switched to TAF/FTC within the first 12 months it was accessible. In step with the identified facet impact profiles of the 2 drugs, renal dysfunction was related to switching to TAF/FTC, whereas switching was much less seemingly amongst these with dyslipidemia. Based mostly on documented renal, bone, and cardiovascular danger components, nonetheless, solely 7% of those that switched to TAF/FTC had medical indications to take action. When indications for switching additionally included danger components for creating renal dysfunction, resembling hypertension and diabetes, as much as 27% of switching was clinically indicated.

The findings point out {that a} minority of switching to TAF/FTC was clinically indicated, though some sufferers seem to have been switched in anticipation of medical indications creating, and others might have had indications for switching that weren’t documented in digital well being data.

“Efforts to finish the HIV epidemic could also be threatened if costlier medicines are used when comparably efficient, cheaper choices can be found,” mentioned co-author Kenneth Mayer, MD, Professor at Harvard Medical College and Medical Analysis Director at Fenway Well being. “Our examine highlights the necessity to make sure that choices about PrEP drugs are each clinically sound and cost-effective.”


Truvada ought to stay first alternative for HIV prevention, specialists say


Extra info:
Julia L Marcus et al, Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide for Human Immunodeficiency Virus Preexposure Prophylaxis at a Boston Neighborhood Well being Heart, Open Discussion board Infectious Ailments (2021). DOI: 10.1093/ofid/ofab372

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Two PrEP drugs are actually accessible. Equally secure/efficient. The most important distinction? The value tag. (2021, August 5)
retrieved 5 August 2021
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