Great point as always, Dan. Still, let's celebrate this discovery, given that we were too wary to celebrate the discovery of anti-retrovirals 15ish years ago. This may/will pave the way towards more practical cures.

Gee, all those Christians who scream "I hope you get AIDS and die!," at Gay Pride parades are going to be so disappointed.

Yes, @2 - how reassuring that it's "only" 20%. Or maybe not.

In the name of being responsible, being sure, being risk-adverse, being the kind of guy who cares about me, my partners and my community...I use condoms even when I know they are probably not necessary...like in that relationship that's just not quite there yet! But I draw the line at taking retro-virals that I don't need. And I'm not looking forward to the day where porno's are contentious of showing Mason Wyler take his daily pill! Not...that...into...this...development!

But like the NYT write up states, some people can't get buy in from their partners to use condoms; some people are at risk of violence if they try. I hope those people can get this drug.

Americans can't finish out their damn antibiotic regimens, let alone an EVERY.DAY.PILL.

Sure, people who need pills to survive take them every day, but even then, there are missed days.

I call bullshit, and I am skeptical with you Dan.

5: Bad news: Mason Wyler is already POZ.

http://www.advocate.com/News/News_Featur…

Dan, sadly your skepticism is about right. The only real cure will be some kind of vaccine. If that was as feasable it should be we would have had one by now.

Yeah, that was pretty much my take on it too.

Not to mention shiny new national health care picking up the tab... oh wait.

I think it's important in terms of progress made in figuring this disease out. I can see based on the knowledge that this works, and going through *how* and *why* it works, we'd be that much closer to finding a cure.

But the practical application of this particular bit of knowledge? Um, yeah. I get why Sullivan's happy -- but as you say, he's part of a pretty small slice of the already small gay male population...

I wonder...women who want reliable hormonal contraception and who don't like taking a daily pill have patches, rings and even small implantable devices that release hormones over time. In the case of the implant, it's good for three years. So, what are the odds that an implantable device could be developed to deliver antiretroviral therapy? It would be more discreet, perhaps, than a pill, and if you can snag a high risk-don't care person even once, you could give them (and their partners) some protection.

And then for some gay men HIV is just another suicide method. Probably the stupidest suicide method you could choose but a method none the less.

@7 Oh that's a shame. But really I just pulled his name at random. Since I guess he will be taking daily retro-virals, if he keeps preforming that make actually be a meaningful thing to portray. But they should keep it in the DVD extras.

I take that back. The porn industry makes way enough on profits to supply every one of their employees with this stuff as needed and maybe that's what they should do. Of course, then we'll see employees being coerced into doing more bareback work. Gotta love human nature.

@10 -- Huh, not a bad idea. Though I have no idea whether these retrovirals are amenable to such approaches.

One small correction - the statistic for higher effectiveness is that those who took the pill 90% were 72.8% protected.
I think this is fantastic news. I understand the concerns, but the more tools we have the better we can fight this. The vaccine studies are still underway and will be the best answer when one is found, in the meantime we should prevent as many infections as we can with the tools at hand.

"The protection, known as “pre-exposure prophylaxis” or “PreP,” is also the first new form available to men, especially men who cannot use condoms because they sell sex, are in danger of prison rape..."

First of all, why is that gay man who sell sex "cannot" use condoms. Last I checked sex workers are perfectly within their rights to set guidelines for their clients.

Second of all, what are the chances that the prison system would be willing to provide all of the inmates in the country with this pill because they may be "in danger of prison rape?" Seems to me that that would be akin to admitting that there are flaws in the system.

Good news, I suppose, but I'll stick with rubbers.

Do we know that the pill alone is what reduced the infection rates? People who are willing/able to take a pill every day for a study might also be the people who are more willing/able to practice other safer behaviors.

Even if someone tried to argue that any such positive secondary effects were worth it from a $14,000 pill, I would think this would suggest that there might be cheaper methods that can be implemented as alternatives that could address at least part of the issue.

It's true that closeted men won't likely be the consumers of a medication like this, but who knows about other high-risk people. This pill is unlikely to be in wide use, but as patents wear out, we might find more convenient methods of having the right amount of these drugs in the bloodstream.

The BCP used to need to be taken every day, but now we've got 3 month injections and weekly patches. Hopefully researchers will be able to figure out how to create methods of benefiting from this drug that aren't a daily pill.

@10: This is what I get for opening the tab and then getting distracted for an hour. Completely repeated your post.

@16 blip,

You're awfully sure of yourself. History is lettered with people who said X will never happen. If the internet had existed 100 years ago, someone would have posted that a polio vaccine will never happen.

Are you an expert? What makes you so confident it will never happen? Considering the resources being thrown at this problem -- and the progress that has already been made -- I think it's more likely to be a matter of when than if. The When might be 50 or 100 years from now, but some things take time.

@19, that's kind of what I thought too and posted on AmericaBlog. Unless everyone in the study is having unprotected receptive with POZ guys, how do you know the value of the pill if that's what you're doing?

@20 Been thinking along those lines since I heard about the study this morning. The cynic in me sees this as a crapcause/effect study. It stands to reason that the people who are dilligent about taking a pill every single day to protect their health are far more likely to embrace other strategies to protect their health.

But releasing the results might get some to pony up $14,000 a year and open a new market/revenue stream for the pharmeceutical industry.

I suspect that if a future study is done on who dillegently took the drug daily as a SOLE means of protection will approach infection rates of people who did very little. There's a giant variable missing in the write-ups of this study.

Excellent analysis, Dan. My first question when I first heard about this was about the side effects, and my second was about the cost and feasibility of widespread usage. Should have also thought about the risk high usage resulting of drug-resistant strains.

Thanks for what feels like the only sensible commentary on this story out there.

$14,000 a year? That's $38 a day! Thats fucking expensive, but here's the deal...it's a major step forward. Major. It's not perfect, and there will be people who take advantage of, or abuse it...but this is a step in the right direction. Twenty years ago when I started volunteering with NW AIDS Foundation, this seemed like a pipe dream. HIV was a death sentence.
This is a big deal.
Please keep using condoms.

Absolutely agree with Dan on all points. Look at the birth control pill, and then think of having to take that tiny pill EVERYDAY forever to avoid getting pregnant. The same applies. Condoms are better, and you can't lie and say, "Oh, I took my pill this morning, don't worry about it," because they have no proof. But they can always sit there and watch you put on a condom. Now here's to hoping people actually follow Dan's advice.

@27: You are incorrect.
Sure, HIV, like all retroviruses, splices itself into the genetic code by using reverse transcriptase. But how does it get into the cell in the first place? The same way any virus gets into the cell; it binds to a receptor protein embedded in the cell membrane, causing it to be internalized. If you create a vaccine that causes the pertinent T cells not to express the protein (and we do know which protein it is), which could be done by delivering an engineered gene to the bone marrow by way of an adenovirus, then HIV would have no way of infecting the patient. There's actually research currently going on in that direction.
Read the literature, blip.

Something I think that stands out?

What do you do when you have partners where one partner is poz, and the other partner is not?

Wear your condoms, yeah, but if it drops the risk that much more...that's a big improvement in life.

It would make sense to give this drug to any gay man in substance abuse situations. That includes everything from tweakers to newly-out college students who get blackout drunk on weekends.

Sure, a rehab program would be a better choice. But in the meantime, maybe the side effects of taking the pill for a year are less important when weighted against having one night of blackout sex followed by a lifetime of HIV meds.

@33: I don't think you're a fucking retard. I just like Bill Nye, and have spent perhaps too much time in the shadier parts of the Interwebs lately. No offense on the personal front.
And actually, we HAVE performed gene therapy, using adenoviruses to insert a functional copy of a gene in people who bear a defective copy. Sadly, human trials were set back a great deal in 1999, when a participant in an early clinical trial died due to a massive immune reaction to the adenovirus used.
Read the literature on gene therapy; it may be a new and fairly hit-or-miss science, but it has bore fruit.

Why is aids research seemingly 100% targeted, and spoken about, in the context of gay sex? Did strait people gain immunity and I missed the memo? Or maybe women? All the commercials on the radio are like, "if you're a young gay male we want your help for an AIDS cure". Now this article, what the fuck?

What we can do, is thank the beautiful gay boys that paved the way for a drug that (if it can ever go generic) that will undoubtedly help women (and men) in parts of the world where women have no cultural or legal right to say no. Like Women in Africa, Or the wives of long distance truckers in India (by far the biggest population spreading HIV to their unsuspecting wives). Heck, if I could afford it I'd use it in combination with Condoms. I'm poly, pansexual and Alergic to latex and not all guys fit into the unstudied non-latex alternatives, thank you, Side effects or not, it beats possibly spreading something to myself or someone i care about.

@31. I was going to pipe up with that idea as well. Except I was thinking of just blocking the CD4 receptor with a specific drug (that hasn't been developed yet). That would be easier than gene therapy or even antisense therapy. It would dumb down the immune system a bit, but done right it might be worth it. And I believe that there are other receptors involved as well. People lacking any one of these receptors I believe are essentially immune to HIV.
And @36 and @39, yes, around the world AIDS is basically a heterosexual disease, something the bigots/trolls always conveniently forget. In some African countries 30% of HETEROsexuals are infected, and we don't judge them as amoral just because of an unlucky encounter with a virus. BTW, As far as Africa, I heard it was long-distance truckers and prostitutes there too. Also there, occasionally and sadly, you can pick up the virus if you go into a hospital for surgery.

This isn't really news. People who have unexpected exposures, such as health care workers who get needle sticks from HIV+ patients and victims of sexual assault by people whose HIV status is unknown or known to be positive, are put on antiretroviral prophylaxis. HIV+ pregnant women are put on antiretrovirals to protect the fetuses, and it works. The problem is that the more you use the drugs, the more the virus adapts to them.

Currently, people who are judged to be compliance risks – i.e., people who are considered unlikely to take a pill "faithfully" every day – are often not prescribed these medications, even though they are HIV+ or may even be symptomatic with AIDS, because taking the drugs irregularly increases the spread of antiretroviral resistance. It's hard to imagine a whole population whose only qualification is high-risk behavior being given the meds.

@10 et seq.:
I, too, hope that there are more automated delivery systems for these drugs or others, but consider a simple hurdle: the drug will have to be stable at about 37C for the life of the implant.

I don't doubt that "they" will be able to come up with this*---speaking as a beneficiary of shelf-stable, time-released insulin preparations unavailable until about a decade ago---but it might take some doing.

*pretty easy for me to say, as I'm not one of them, yet.