Prophylaxis via organ failure and bankruptcy

A year ago, I wrote:

“Clinical trials on human beings are under way to gauge how well tenofovir and emtricitabine protect against HIV infection, with the hope that a regular diet of them could be recommended as prophylaxis. It’s already known, mind you, that these drugs can produce bone demineralization with chronic use, kidney damage, lactic acidosis (including fatalities), liver damage (including fatalities), and liver cancer. The danger of side effects is greatest when first starting the drugs but also when one stops taking them.” Read the rest of this post [“To avoid HIV later, damage your kidneys and liver now” , 19 January 2008]

Why would anyone contemplate such a highly risky procedure to avoid a condition which, IF contracted, can be managed satisfactorily? After all:
“Today any HIV/AIDS patient who sticks with a medication regimen will be successful in keeping AIDS under control, . . . said clinical pharmacist Neha Sheth, PharmD, assistant professor at the University of Maryland School of Pharmacy. Sheth was among a panel of experts who presented a two-day minimester titled ‘Women: The Changing Face of HIV/AIDS’ this month for students from the University of Maryland schools of social work, dentistry, law, nursing, medicine, and pharmacy.”

But even if this is too rosy a painted picture: IF a person does happen to become “HIV-positive”, there follows on average a decade of asymptomatic life without drugs that have dangerous “side”-effects; and IF illness ensues at any time, it would be treated, at worst with the same medications having the same highly dangerous “side”-effects as from the “prophylaxis” under test, at best with newer medications with lesser “side” effects that are continually being introduced. Prophylaxis under these circumstances seems like a losing proposition — but clinical trials continue:

“HIV Prevention Pill Nearing End of Trial
In June, people on three continents will know if the pills they’ve been taking to prevent HIV infection were the real thing or placebos. As the test of tenofovir, said to be an HIV prevention pill, nears the end of the trial period, questions of its effectiveness remain. Researchers worry that the pill’s success may tempt people in high-risk lifestyles to be even more risky, thinking of the pill as a safety net against infection.
The tenofovir pill, PreP (pre-exposure prophylaxis for HIV prevention), is being studied as a result of the drug’s ability to boost temporarily the immune system enough to fend off HIV infection by about 80% when administered within just a few days after exposure. Study participants are taking the pill, or a placebo, on a daily basis, however, to determine how effective a prevention it can be.
At this time, the most effective means of preventing exposure to the AIDS-causing virus is to use condoms when engaging in sexual activity and to avoid other risky behaviors. Doctors fear potential patients taking the prevention pill may forego the use of condoms, expecting the pill to eliminate all risks of infection. The patients for whom the pill proves ineffective may unknowingly spread the virus to others before the pill’s performance on the individual is determined, a situation that may spread the AIDS epidemic even further rather than keeping it in check.
Dr. Albert Liu says he’s heard of people using PreP and other antiretroviral drugs in lieu of condoms outside the study’s parameters and before the drug went into the trial phase. Liu is director of HIV prevention intervention studies at San Francisco’s Department of Public Health. He and his colleagues fear this misuse of the drug will counterbalance any benefits.
Doctors warn PreP is not a pill to pop before a night on the town and other precautions must be maintained as well for maximum benefit. As tested, it is a daily medication that comes with side effects that have been linked to kidney and liver damage.
Another area of concern is cost. As currently marketed, a daily supply could cost between $500 and $900 per month, with cost depending upon an individual patient’s access to insurance coverage and variables from one insurance carrier to another. AIDS activists are hopeful the cost would drop if the drug becomes widely prescribed.”

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In sum: IF the process being tested were to prove effective in preventing people from becoming “HIV-positive”, it would be likely to encourage riskier behavior and a greater chance of spreading “HIV”, as well as exposing those taking the pills to highly dangerous “side”-effects a decade or more earlier than would be the case if they were not “taking advantage” of prophylaxis; all at an annual cost of ≥$6000.

This is a “lose – win” situation:
Lose for “pre-patients”, for their sexual partners, and for taxpayers, since payment for HIV/AIDS treatment is guaranteed by the federal government (unlike for any other illness, disease, or personal tragedy — in those cases, it would be unacceptable socialized medicine).
Win, however, once again, for the drug companies and their lobbyists — and, of course, for the researchers and doctors who get the grants and the consultant fees. Read what a former editor of the New England Journal of Medicine has to say about “Drug Companies & Doctors: A Story of Corruption”, even apart from the HIV/AIDS business.