PrEP *podcast*

Next level propaganda; also if you listen closely, lenacapavir is not in fact “perfect”

Speaking of the Journal of the American Medical Association, I received the link to the following podcast. JAMA Senior Editor Karen E. Lasser, MD, MPH (professor of medicine at Boston University) interviews Dr. Monica Gandhi of UC San Francisco about “PrEP options.” I highly recommend listening to the whole thing because the entire podcast is simply encouraging “retention in care” at any cost. The word “adherence” is repeated multiple times. I didn’t bother to count how many.

Preexposure Prophylaxis (PrEP) Options for HIV

We begin by stating that “We are not preventing ‘HIV’ at the rates that we would like to.” Oh, snap. People don’t want to take toxic drugs for a condition they don’t even have? Say it isn’t so. They continue by asking what PrEP is and who should receive it. “PrEP should really be given to anyone who’s at risk for ‘HIV’ infection.” And who, exactly, is “at risk?” The answer is men, women, anyone who asks for PrEP, anyone who has had an STI in the past year, and anyone who has or has had more than one partner. This certainly casts a wide net.

They then spend quite some time discussing the different options for PrEP, beginning with “bad Truvada,” which they admit is by far the most commonly used option. They cite our friend, the iPrEX study. Dr. Gandhi admits that the efficacy in this trial was only 44%, but then cautions that efficacy may increase with greater adherence. Already, we’re onto bullying people into being “retained in care.”

They then move onto the injectable, cabotegravir (given every other month), as well as lenacapavir, which has yet to be approved, but is “so potent” that it only needs to be given twice yearly. I wonder what the toxicities are for that regimen. Furthermore, they do mention the “zero seroconversion” study among “cisgender women,” (the Purpose 1 trial) but follow up with the results of the follow-up study (the Purpose 2 trial) of MSM and transgender women, where efficacy drops to 96%, and will surely drop even further with more research. So we know it isn’t perfect, and we also know that these medications perform much worse “in the wild” than in clinical trials. She also mentions how dismally “good Truvada” performed in the Purpose 1 trial, which as have already shown is no better than the “background incidence” of “HIV.”

The main thrust of this podcast seems to be that we need multiple options for PrEP, so that patients can have a choice of what kind of PrEP they would prefer to take. “We would like access… we want accessibility… especially with the injectables.” Well, injectables every few months will certainly help with “retention in care,” but I can’t help but to wonder what kind of crazy toxicities we might see with such “potent” doses.

Really, this entire podcast is all about increasing adherence. That’s not creepy at all. Dr. Lasser poses the question, “What are some strategies you propose to increase adherence?” This is where things get really wild. Among the strategies to increase adherence are the following: “peer support” (whatever that means), SMS text messaging (can you imagine getting a text asking if you’ve taken your meds?), or pill box reminders. But perhaps the creepiest strategy of all is the “urine tenofovir assay,” which is basically the equivalent of a pregnancy test—you pee on a stick and it tells you whether or not you’ve taken your PrEP drugs. Yes, this is a real thing. What happens if your urine test is negative for PrEP? (Wouldn’t you know if you’ve taken your pill?) Well, by “counseling” around that test—“great job! Keep it up !” Or “how can I help you with your adherence?” WHAT?? How do the powers that be know you’ve peed on a stick, and what the results are? I’m actually really curious about that.

They then discuss “on demand PrEP,” which basically amounts to a form of PEP (2-1-1; 2 pills of Truvada before the “risk exposure” and one pill within 48 hours of the “risk exposure”). This doesn’t sound very practical.

Finally, they discuss why PrEP uptake has been disappointing thus far. The short answer is that we need to treat PrEP like the birth control pill (which is falling out of favor among women due to its side effects and carcinogenic potential), meaning that not just infectious disease specialists but all general practitioners ought to be pushing PrEP—toxic anti-“HIV” drugs, as a reminder—onto just about every “HIV” negative person that is willing to take it. This is absolute insanity. “It’s not being widely prescribed by general care practitioners or emergency medicine providers.” (That’s a paraphrase.)

It’s only at the 12 minute mark of this 14 minute podcast that the potential adverse effects are even mentioned, and they are discussed in a very casual, throwaway manner. Dr. Ghandi admits that there are concerns regarding renal impairment and bone loss that perhaps might benefit from twice yearly monitoring. And, of course, we need quarterly “HIV” tests. Who’s making money off of this craziness?

So let me get this very clear. We are, according to the “experts,” not currently prescribing these toxic medications with well-documented devastating side effects to enough individuals that don’t even have the condition that these drugs were developed to treat? What kind of post-apocalyptic society are we living in? This is utter madness, yet these medical professionals discuss it as casually as one might discuss the benefits of eating more fruits and vegetables.

TL;DR: They want to give PrEP to everyone. As Dr. Ghandi concludes, “Just assess and go ahead and prescribe PrEP.” (Emphasis mine.)

I don’t know about you, but this is insane to me. What do you think? And if you have listened to the whole 14 minutes, I’d love to know your thoughts.