Saturday, September 3, 2011
Though it doesn't stop the vigorous campaigning by Gilead to fast-track the approval process for it's Truvada antiretroviral drug for use as pre-exposure prophylaxis, little enough is known about the consequences of a large scale PrEP program. But also, the results of trials so far are far too poor to support widespread use.
The Aids Healthcare Foundation, who are opposed to this fast-tracking, have also highlighte another serious consequence. A serious black market in Truvada has emerged and one US state has passed a law so that the drug can only be prescribed when someone has been diagnosed as having either HIV or hepatitis.
Whatever the consequences of such market manipulation in the US, the same phenomena in developing countries could be very serious. Most people in high HIV prevalence countries receive medication paid for by donors. There is no current funding for PrEP. Therefore, drugs people are not receiving free of charge could rapidly increase in value in a black market.
The ethical problem of supplying a drug that is in short supply to people who are not HIV positive has not been addressed. But the ethical issue of creating a run on a drug that is keeping many people alive, just so some people can try out a HIV prevention strategy that is very unlikely to give them much protection, is also in serious need of consideration.
New HIV infections are not a problem for Gilead, far from it, they are all very welcome news. The development of resistance to cheap drugs is even more welcome as revenue from each 'customer' increases by as much several hundred percent.
Even a few deaths will not put much of a dent in profits, considering the customer base is being increased from a few million HIV positive people to a possible several tens, or even hundreds of millions of HIV negative people added to the current highly lucrative market. The article notes that the drug generated $2.6 billion in revenue in the last year and use of Truvada as PrEP could add anotehr billion to that.