By Seth Lamming
From PHN Issue 41, Winter 2020
In October 2019, the Food and Drug Administration approved a new medicine, Descovy, for pre-exposure prophylaxis (PrEP) to prevent HIV. PrEP is a drug regimen that people can take daily or on a particular schedule to prevent getting HIV from sex. PrEP has not been proven to be effective in preventing HIV transmission through needle sharing. Descovy (made up of emtricitabine and tenofovir alafenamide) and Truvada (made up of emtricitabine and tenofovir disoproxil fumarate) are the only two medications that can be used for PrEP. They are both frequently prescribed as treatment options for people who have HIV. Descovy and Truvada are both nucleotide reverse transcriptase inhibitors, which means they stop HIV
DNA from being copied from its RNA blueprints. This stops HIV from replicating. Most people in prisons and jails are not prescribed these meds for PrEP. The “logic” is that people in prisons and jails do not need PrEP because they are not allowed to engage in sexual activities while incarcerated.
Descovy is not actually a new medication, even though it just got approved for use as PrEP. It was first released in 2016 for HIV treatment, and it contains an updated antiviral ingredient called tenofovir alafenamide, a newer version of tenofovir than the version in Truvada. Truvada has been around since 2004 and was approved as a medicine for PrEP in 2012. Descovy and Truvada are both made and sold by a drug company called Gilead Sciences. While the release of a new drug that can both treat and prevent HIV is a positive move towards ending HIV, advocates have some issues with the drug company’s actions.
First, Descovy has not not been approved for use by cisgender women or transgender men. Whenever a new drug is approved for public use, it has to go through clinical trials before the medicine is available to the public. Clinical trials are a series of tests that prove a medication is safe and effective and show possible side effects. Clinical trials for Descovy only tested the effectiveness of the medication in cisgender men and transgender women. In other words, Descovy has not been proven to stop HIV from replicating in vaginal tissue. Gilead’s decision to not include cisgender women and transgender men in clinical trials has caused outrage among HIV/AIDS activists across the country. Critics have stated that Gilead did not want to spend money on clinical trials for women because men who have sex with men form the bulk of the market for PrEP, in the United States anyways…
Second, Gilead is claiming in its advertising that Descovy is safer and more effective than Truvada. All medications have the ability to cause side effects. A medical provider’s decision to prescribe medication takes the risks and benefits into account. If the health benefits of taking a medication are greater than the risk of side effects, then it is worthwhile to take amedication. Clinical trials showed that Descovy is less likely to cause kidney damage and bone weakening than Truvada. However, Descovy has a higher risk for causing weight gain and cardiovascular disease than Truvada. What does not sit right for many people is that Truvada will lose its patent in 2020. Advocacy groups have criticized Gilead’s messages about Descovy being safer and more effective than Truvada as an attempt to get consumers to switch over to the newer medicine, which will be more expensive ($1,758/month). When Truvada’s patent runs out soon, other drug companies will be able to make generic, off-brand versions of the same medicine and sell them for a lower price.
There is currently a class action lawsuit directed at Gilead in the midst of accusations that Gilead delayed development of Descovy in the early 2000s despite the fact that they knew Truvada had long-term side effects that could damage bone and kidney health. Advocates believe that Gilead did this in order to continue making money off of Truvada while its patent was still in effect. The class action lawsuit mainly deals with people who are taking Truvada for HIV treatment—not for HIV prevention. However, ads on television and social media have created some panic about the safety of Truvada for PrEP. This might discourage some people who are at high risk for HIV from taking PrEP.
Although PrEP is not an indication for most people to take Truvada or Descovy on the inside, many may be taking these medications for treatment. At your next medical visit, you can ask the medical provider when the last time your kidney function, liver function, and comprehensive metabolic panel labs were done. These are the most basic tests that should be performed routinely when you are taking lifelong medications.