Update on Descovy for PrEP and Treatment

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.

The Real Deal on HIV Transmission

By Elisabeth Long

From PHN Issue 38, Fall 2018

The Human Immunodeficiency Virus (HIV) is not spread easily. There are a lot of myths about how people get HIV—from mosquito bites to sharing utensils to toilet seats to coughing and sneezing. None of these are true. The reality is that HIV is only transmitted when a body fluid that carries a high concentration of HIV gets into the bloodstream. Mainly, HIV transmission occurs through unprotected sex and sharing drug use equipment. Fortunately, the risk of HIV transmission can be reduced in
a number of ways. Continue reading “The Real Deal on HIV Transmission”

Searching for an HIV cure

By Kirsten Sandgren

From PHN Issue 36, Spring 2018

The human body has a truly amazing set of defenses against infection. Considering how much our bodies are exposed to in the course of our day-to-day lives, it’s a pretty rare occurrence for us to get sick. Even when we do become ill, the immune system is able to recognize the invader, signal to the many different cells that are responsible for keeping us healthy, and almost always come out victorious. Despite this, Human Immunodeficiency Virus (HIV) is able to cause lifelong infection. HIV affects over one million Americans and more than 37 million people around the world.There is no cure for HIV/AIDS currently, but there is promising research being done to improve treatment and hopefully find a cure in the future. Continue reading “Searching for an HIV cure”

Risk of Sexual Transmission of HIV from a Person Living with HIV who has an Undetectable Viral Load

Reprinted with permission from the Prevention Access Campaign

From PHN Issue 34, Fall 2017

There is now evidence-based confirmation that the risk of (sexual) HIV transmission from a person living with HIV (PLHIV), who is on Antiretroviral Therapy (ART) and has achieved an undetectable viral load in their blood for at least 6 months is negligible to non-existent. (Negligible is defined as: so small or unimportant as to be not worth considering; insignificant.) While HIV is not always transmitted even with a detectable viral load, when the partner with HIV has an undetectable viral load this both protects their own health and prevents new HIV infections.[i] Continue reading “Risk of Sexual Transmission of HIV from a Person Living with HIV who has an Undetectable Viral Load”

Safety and After-care for Prison Tattoos

By Tracey Hamilton

From PHN Issue 32, Spring 2017

The primary fear most people express about getting tattooed in prison is that they may contract the HIV virus, which may cause AIDS. HIV is only one of many viruses that can be transmitted. Syphilis, tuberculosis, strep, staph, and hepatitis are just a few of the other diseases to take into consideration. Continue reading “Safety and After-care for Prison Tattoos”

My Involvement with the HIV/AIDS Awareness Program at the Oregon State Penitentiary

By Timothy Hinkhouse

From PHN Issue 27, Winter 2016

In the mid-1990s, it was brought to the attention of the health staff at the Oregon State Penitentiary that an HIV/AIDS education program needed to be assembled to educate the population about this “scary new disease.” The Oregon Health Department contractor who was doing the HIV testing and counseling at the time brought it to their attention because she lost her brother to AIDS and she wanted to help those still alive. A team of incarcerated people who worked well together put together an outline for an education program, the HIV/AIDS Awareness Program (HAAP). We came together because we were on the same page about the necessity of reducing the rate of new infections and clearing up prevalent misconceptions about exposure and transmission. Continue reading “My Involvement with the HIV/AIDS Awareness Program at the Oregon State Penitentiary”

Truly Understanding the Connection between HIV and Incarceration

By Laura McTighe

From PHN Issue 24, Spring 2015

   We know that HIV and incarceration overlap. One in seven people with HIV will pass through our prisons and jails this year. But knowing that HIV and incarceration overlap doesn’t tell us why. Understanding why is critical if we are to end AIDS. Continue reading “Truly Understanding the Connection between HIV and Incarceration”

Ending the Spectrum of Violence Against Women: The Positive Women’s Network

By Teresa Sullivan

From PHN Issue 21, Summer 2014

“We, as women living with HIV, envision a life free from violence, coercion, and discrimination for all people. We, as women living with HIV, demand an end to the many different forms of violence faced by all women, including physical, emotional, psychological, religious, sexual, institutional, and economic violence, and the trauma that violence leaves in its wake.” —Positive Women’s Network, USA

When we hear the word “violence,” the first thing we visualize is the physical abuse of someone. And women living with HIV are indeed vulnerable to physical violence because of stigma and ignorance. This reality was made brutally clear yet again a few weeks ago with the heartbreaking murder of Elisha Henson, who was killed in Texas because of her HIV status. A survey conducted by the Positive Women’s Network, USA (PWN-USA) last year found that 72% of women living with HIV who responded were survivors of intimate partner violence. However, for PWN-USA, ending violence against women includes ending a spectrum of human rights violations, including but not limited to physical violence, that women have faced for many generations throughout history. Continue reading “Ending the Spectrum of Violence Against Women: The Positive Women’s Network”

There’s No Shame in Love

by Jose de Marco

From PHN Issue 19, Winter 2014

I’m Jose de Marco. My father was Latino, my mother was African-American. I’m a man that loves other men.

   I believe if people were more accepting of who they are, they would not care when other people criticize them about who they love. But you have to get to the point where outside influences—whether it’s church, your teacher, your mother, or your brother—your happiness cannot depend on the permission of other people. Continue reading “There’s No Shame in Love”