More trouble for Gilead and the NRTI drugs

(Back from vacation)

Well, Gilead is facing yet more problems with their NRTI (nucleoside analogue reverse transcriptase inhibitors; something of a misnomer since they are indiscriminate DNA chain terminators) drugs, which include both “bad Truvada” (tenofovir disoproxil fumarate; brand name Truvada when paired with emcitricabine) and “good Truvada” (tenofovir alefanamide; brand name Descovy, also paired with emcitricabine). Apparently their NRTIs have been associated with a substantial risk of glaucoma, leading to potential blindness. Check it out:

Side Effects of Truvada, Other NRTI Drugs Used To Treat HIV Could Cause Glaucoma: Study

The findings of a new study raise concerns that some antiviral medications used to treat HIV could increase the risk of an eye disease known as primary open-angle glaucoma (POAG), which can lead to blindness.

[…]

However, according to a study published in the medical journal Ophthalmology late last month, those same drugs appear to also be linked to an increased risk of POAG, which is the most common form of glaucoma. The condition causes a build-up of fluid pressure in the eye which can damage the optic nerve, causing vision problems, including blurred vision and even blindness.

These drugs certainly cause the laundry list of severe adverse events—so far we have liver and kidney damage, bone density loss, cardiovascular problems, anemia, IRIS (immune reconstitution syndrome), and now glaucoma. Lovely.

This study was not a small one, either—it enrolled over 300,000 participants.

Interestingly enough, the article discusses the Truvada disaster, effectively touching the third rail, if only lightly.

The HIV drugs market has been dominated for years by Gilead, the original manufacturer of Truvada, Viread, Descovy and other antiviral medications used to treat the disease. The manufacturer has faced tens of thousands of lawsuits over Truvada and other HIV drugs throughout federal and state court systems for years.

Complaints filed by former users of the HIV drugs, who suffered bone fractures and kidney problems, allege that Gilead delayed development of a safer formulation for its medications, involving the compound tenofovir alafenamide fumarate (TAF), used in Descovy. Plaintiffs say Gilead sat on the safer TAF-based HIV drugs until the existing patent on older tenofovir disoproxil fumarate (TDF)-based medications neared its end, in order to maximize profits and avoid generic competition.

In June 2024, Gilead announced it had reached a $40 million Truvada settlement to resolve more than 2,600 such claims in federal courts nationwide. However, it still continues to face tens of thousands of claims pending in California state court, which are expected to go before juries if the drug manufacturer fails to reach a settlement to resolve those claims as well.

The cynic in me is wondering if the media is suddenly reporting on the toxicities of NRTIs—easily the most prescribed PrEP and ARV medications—in an attempt to have the long acting injectables be the standard of care. After all, lenacapavir, the great hope of the “HIV” industry is not an NRTI but a capsid inhibitor. Are articles like these priming us for near-exclusive prescription of lenacapavir, with all the attendant creepy problems that are associated with long-acting injectables? One has to wonder. However, if this does eventuate, the adverse effects of such concentrated drugs might well dwarf anything we’ve seen from Truvada.