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.

Second issue of Turn It Up! prison health magazine now available

Our sister publication, Turn It Up! Staying Strong Inside, has just released its second issue! This is a beautiful, detailed and comprehensive resource for people in prison about how to survive, thrive and advocate for their health. Turn It Up! is published by the SERO Project.

You can read it online here and order a copy for your loved one in prison here.

Visit TheBody for a wonderful interview with the editors.

Words to Live By

Advice from a formerly incarcerated person living with HIV

From PHN Issue 37, Summer 2018

1. Take care of yourself. Make your health your top priority. Ask for what you think you need. Don’t wait for someone to take care of you. Advocating for your health is a constant job, especially in prison or jail. Continue reading “Words to Live By”

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”

HIV and Hepatitis C Co-Infection

By Lucy Gleysteen

From PHN Issue 35, Winter 2018

Finding out that you have both HIV and hepatitis C can be difficult. Some people can be living with HIV and/or hepatitis C and not know their status because it sometimes takes a long time for symptoms to appear. If you think you might have contracted HIV or hepatitis C, you can ask your doctor to provide testing. According to the US Department of Health and Human Services guidelines, prisons should provide testing. Continue reading “HIV and Hepatitis C Co-Infection”

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”

HIV Drug Resistance and the Importance of Taking Your Medications

by Eric Ward

From PHN Issue 33, Summer 2017

If you have HIV, your prison should treat you during the time you are incarcerated. There is no cure for HIV, but taking the HIV meds will allow you to live longer and with fewer symptoms. Taking your HIV meds as prescribed can also reduce the risk of transmitting HIV to other people. Continue reading “HIV Drug Resistance and the Importance of Taking Your Medications”

How I’ve Protected My HIV Health

By Timothy Hinkhouse

From PHN Issue 31, Winter 2017

I have been going back in time with my thoughts to when I was newly diagnosed with HIV in 1990. Some serious thought has been put into how I’ve managed to live this long, so many years beyond the original expiration date given by the doctor who broke the news to me. I was 19 when I was told of my HIV diagnosis. With the lack of medications and knowledge of how to manage this disease, I was going to die before I was 22 years old. So I was told. Continue reading “How I’ve Protected My HIV Health”

Preparing for Your HIV Care on the Outside

FROM THE 2016 DISCHARGE PLANNING MANUAL

From PHN Issue 30, Fall 2016

If you are going to be released, there are a lot of things to think about first. Are you going to get medical assistance? How will you continue to get medical care for your HIV? Where is a good medical provider you can see? What happens if you can’t pay for medical care? How can you make sure that you won’t miss any medications? Does your prison or jail give you a supply of medications, a medical discharge summary and/or the name of a doctor to see once you are out? There is a lot to plan for. Below are some tips to help you to plan for your HIV care on the outside. Continue reading “Preparing for Your HIV Care on the Outside”