Dr. Damien P. Williams: Like TSCC s03 John Connor, But Better: Lenacapavir did so well at preventing HIV infection that it hit the threshold where the only ethical thing to do was stop the randomized trial and immediately offer it to literally every participant. That's huge news. www.npr.org/sections/goa...

Lenacapavir did so well at preventing HIV infection that it hit the threshold where the only ethical thing to do was stop the randomized trial and immediately offer it to literally every participant. That's huge news. www.npr.org/sections/goa...

A new way to prevent HIV delivers dramatic results in trialwww.npr.org The testing of lenacapavir was halted because results were so impressive — 100% effectiveness. The decision was made to give all participants the injection rather than the alternative daily pill.

. . . oh my gawd that has GOT to be a record for the most fluoridated pharmaceutical molecule and it has a carbon triangle to boot

I uh. I want to understand your post but could use some help

NAD but Google says

“It’s made of diamonds” 💎

Fluorine is the most electronegative element, meaning it pulls on other atoms' electrons the strongest. Natural biology doesn't make much use of fluorine, perhaps because it's a chemically-difficult element, perhaps because it's not very prevalent.

Depending on what the fluorine is bonded to, fluorine-containing compounds will typically either be exceptionally stable (fluorine is happy with its electrons) or exceptionally reactive.

Since organisms mostly don't naturally use fluorine, a well-placed fluorine can enhance a molecule's activity in a very targeted way that no naturally-occurring could pull off. Well, that's as far as my memory of basic chemistry can take me.

I'm guessing all those fluorines are there to target the drug very narrowly, either reducing its propensity to attack non-HIV things, or enhancing its propensity to attack its target. Possibly both? That's a question for Derek Lowe, an actual chemist.

Warning: chemical pedantry. Fluorinated, not fluoridated. And yeah, that's a structurally complex molecule. For a bunch of reasons.

AH! I knew that didn't look quite right, thank you.

I thought "How bad can it be?" I looked it up. That's...wow!

inorite??

The whole thing looks odd!

Well I'm no chemist so I don't know what "odd" would look like, I just know enough to know that's a lot of fluorine.

Unblinding a study like this is rare. And wonderful.

You buried the lede! A single 6 months Prep shot. No infections out of 1000 ppl, effective for women.

And they’re even committed to getting it to the global south!

I don't think the drug company is. It's a brand new salvage drug.

The article was a bit confusing on that. Even licensing it to generic manufacturers before the patent expires is pretty big, sadly.

Never mind. My stressed out reading comprehension last night made it seem that way 🙊 I apologize!

Good news for Australians, though

”Treatment Action Group” wants to do that. This is unlikely to happen very soon on a brand new drug, especially one needed for AIDS salvage. This might just be anticipatory activism. There didn't appear to be an arm for Cabotegravir, the only injectable Prep on the market.

The... global south? As an Aussie, not sure if insulted or amused. Pretty sure you aren't aiming at us, but that seems to be a pretty awful scatter shot even so.

Yesssssss

I really hope there are no bad side effects, 'cause this is a *marvel*.

This article is so grim. "New miracle drug, but probably won't be viable because of capitalism"

📌

In the most of hell, profoundly good things are still happening. 😮‍💨

Depths, but who cares about typos when lives are being saved?

There are many similarities between HIV and COVID-19. It would be nice if they could to a COVID trial for this drug.

📌

They’re using a high power last-resort (for mutidrug resistant HIV) treatment drug as a preventative. Doesn’t this strike anyone else as potentially a bad idea?

is it last resort because of side effects or because it is currently very expensive

I think because it’s new. Which means it’s expensive but also that there’s no evolved resistance yet. Widespread use as a preventative seems likely to put that at risk.

isn’t evolved resistance to tenofovir not really a problem yet?

Read the article; It ain't a new drug, but the price is a massive jump. ~50 bucks a year for PrEP, ~40 grand a year for lenacapavir. They spend half the story talking about the adventure it will be making this accessible.

Introduced in 2022 is pretty new.

The dynamic here is more that it's now plausible that we could eliminate HIV completely, as we eliminated smallpox; it's a virus with no reservoir outside humans and we now know how to stop its transmission completely. Impressive work.

I see that possibility too. It would require that they undertake a no-shit eradication campaign tho and not mess around. Given recent track record with global drug/vax distribution my confidence on that front is not high.

All the HIV preventives except abstinence and condoms were treatments for HIV first. PreP has prevented perhaps millions of seroconversions and is cost-effective compared to treating HIV+ patients. My understanding is the risk of HIV mutation under PreP is very low, and carefully monitored.

It's not quite like antibiotics, in particular because being on PreP for HIV comes with wraparound services for HIV testing and testing of other STIs. If we had evidence that using antivirals for PreP was allowing drug-resistant HIV to spread, I haven't seen/heard it (tbh, haven't checked).

This trial hits on the one remaining weak spots for PreP in HIV prevention, which is that the daily pill requires strong adherence to prevent infection. If adherence goes from "daily pill" to "twice-annual doctor's visit" and takes us from 99% protected to 99.99999*% protected? IMO, worthy.

Yes, it does. Conflict of interest.

I wonder if it is possible to learn anything from it for making other drugs a success too?

awesome!

📌

This is wonderful news.

📌

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