PrEP Roundup; 30 “HIV leaders” to look forward to

It’s time again for our semi-regular roundup of PrEP- related news, and the theme seems to be that people don’t actually want to take PrEP all that much. Of course, the solution to this problem seems obviously to be, in the minds of the HIV AIDS establishment actors, long-acting injectable PrEP—actually, ultra long-acting injectables—because the only reason they can fathom for PrEP refusal must be the inconvenience of a daily pill, and can’t possibly have anything to do with either the side effects or, just maybe, the fact that they have no reason at all to take a medication for a condition they have no hint of even having. This theory of mine is further supported by the increasing promotion of “event-driven PrEP,” which is basically on-demand PrEP and is functionally indistinguishable from PEP (post-exposure prophylaxis).

Here are five short pieces, followed by a link to an inspiring piece about “30 ‘HIV’ leaders to watch.”

Injecting drug users refuse PrEP

The amount of hand wringing over “PrEP refusal” and “PrEP discontinuation” smacks of desperation. The reality is that fully one third of “HIV positive” individuals are not even taking antiretroviral medication, yet there is no AIDS epidemic comparable to that of the 1980s and early 1990s. This is a huge story that deserves a far wider audience. And these are the people that officially have the condition being treated; no wonder the people that don’t even have it are refusing its treatment en masse.

Too five PrEP stories from a conference no one’s heard of

There isn’t much interesting here, although I’m noticing more and more advertising of “event driven PrEP,” which means taking PrEP only when you think you are at risk of exposure, which—isn’t that just effectively PEP? (Post exposure prophylaxis?) Given the continuing PrEP refusal, this seems like yet another desperate attempt to market “anti-HIV drugs” to “HIV negative” individuals. Why change the language?

Event driven PrEP

Just copy and paste that last paragraph. Here’s the one and only quote I will give you from this piece, because this is all verbal gymnastics at this point, but I want you to see the stellar state of “HIV AIDS” research:

The first ‘dogma’ Stewart challenged was that event-driven PrEP “only works for French men”.  This was because the only randomised placebo-controlled trial of this method, the IPERGAY trial, took place in France, where it proved to stop 86% fewer infections than placebo. (In the regimen used in IPERGAY, two pills were taken 24 hours before sex, then one 24 hours after, and another one 48 hours after the double dose.) This was exactly the same efficacy reported by the UK’s PROUD trial of daily PrEP, thus proving that the two methods were equally effective – but some PrEP guidelines continue to be cautious about it, and two influential guidelines still don’t recommend it for anyone.

Yet ‘2-1-1’ PrEP has since been widely promoted elsewhere to gay men from Australia to San Francisco  without any apparent difference in HIV incidence compared to daily users.

Does anyone find that entire block quote truly bizarre?

Ultra long acting PrEP and ARVs

I can’t see any potential danger in this. This long acting injectable business is actually terrifying to me. From the article:

The approved formulation of cabotegravir for PrEP (sold as Apretude) is now the longest-acting HIV prevention method, and long-acting cabotegravir plus rilpivirine (Vocabria and Rekambys) is the longest-acting complete HIV treatment regimen. (In North America and Australia, the two drugs are packaged together and sold as Cabenuva.) Both PrEP and treatment involve intramuscular injections in the buttocks administered by a health care provider every other month. (A once-monthly dosing schedule for injectable cabotegravir and rilpivirine is approved in the US and Australia, but is not available in Europe.)

One strategy to achieve less frequent dosing is to increase injection volume or the concentration of the formulation. (ViiV researchers presented an analysis of one high-concentration formulation of cabotegravir at the 2022 International AIDS Conference.) Another approach is to develop a longer-acting formulation that is absorbed more slowly and has a longer half-life in the body (the time it takes for the drug concentration to fall to half its original level).

Rilpivirine is a medication we haven’t discussed here, but it’s a “non-nucleoside analogue reverse transcriptase inhibitor,” or NNRTI. (Again, I remain fascinated at the disappearance of the protease inhibitors.) Regardless, is anyone able to explain to me how this is going to work, giving larger concentrations or volumes of the same medication less frequently, when the official story behind these drugs is that they “interrupt the virus at every stage of replication?” Are these formulations really so sophisticated that they magically dispense small doses of stored drug at precise intervals to interrupt said replication? And what about the assault on the kidneys, liver, and bones that must happen when a patient is given such a massive dose of drug? This is not the same as vaccine technology, yet the public health establishment seems to think it’s a good enough substitute for the vaccine that will never eventuate.

PrEP use in pregnancy doesn't raise the risk of adverse pregnancy or birth outcomes

Have we learned nothing?

Oral PrEP consisting of tenofovir disoproxil (TDF) and emtricitabine taken during pregnancy does not increase the risk of adverse pregnancy or birth outcomes such as low birth weight, miscarriage or neonatal death, a South African study reports in the journal AIDS.

I wish I could say I can’t believe this is serious, but unfortunately I can believe it. There is a very specific categorization of pregnancy safety among all prescription medications, and TDF is in Category B. According to this paper, Is tenofovir/emtricitabine teratogenic?, “The US Food and Drug Administration categorizes Truvada as a category B drug, which implies that animal reproduction studies have not demonstrated foetal risk and there are no adequate controlled studies in pregnant women.” (Emphasis mine.) Disturbingly, this very same paper also reports on two cases of spina bifida in infants whose mothers were on Truvada and nevirapine during their pregnancies. And, again, we’re discussing Truvada here, whose dangers are well known at this point, though not nearly widely enough known.

30 “HIV” leaders

This is so inspiring, guys:

Anniversaries present an opportunity to pause and reflect—not only on the progress that lies along a journey but also on the challenges ahead. In the HIV community, we know that these moments are great for sharing knowledge and refueling. That means POZ’s 30th anniversary is a perfect time to share wisdom gained in the fight against HIV. To that end, we spoke to 30 leaders in the HIV community and asked them each a question about an aspect of the ongoing AIDS epidemic that they know best.

Yes, and I’d add that the fortieth anniversary of the infamous Gallo/Heckler press conference announcing the “probable cause of AIDS” to the entire world prior to any supporting papers having appeared in the medical literature is certainly going to be a time to pause and reflect on many things. I won’t torture you with any quotes from any of these “leaders,” although I will point out that I’ve only ever heard of one person on this list, which seems to be very carefully curated to further a particular agenda not limited in its scope to HIV AIDS.

That’s all for today, people. As always, chime in in the comments!

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If you’re a new reader and would like some background as to my views on HIV AIDS, including the “existence” question, please refer to this post and the links contained therein. My interview with Sam Bailey is also a great introduction.