TRUVADA: Why are we ALL not taking this???!!!!

[trish]

I understand the need to quantify these numbers out of skepticism or what have you

You can't quantify numbers. They're already numbers. The studies have been done. The results have been analyzed. The problem is the results are being reported half-assed.

The trouble with bandying about phrases like “it’s 95% efficient” or “it’s 99% efficient” is that they’re meaningless without having available all the other numbers and conditions are are used to defined them. The danger with such phrases is that 95% efficient can sound wonderful, and on short runs it is. But on a twenty year stretch (which is not rare for domestic partnerships) 95% efficiency could mean a 64% chance of contracting AIDS.

Do you want to avoid testing positive for a year, or for a lifetime?

The same can be said of side-effects. The odds of suffering, say from liver damage, as a side effect of using BrandX may be small in the course of one year’s usage at the recommended dose. But the probability of dangerously damaging your liver over the course of one or two decades may be considerably higher. Again we need to know dosages, number of incidences out of samples of participants and confidence intervals to make any intelligent choices (i.e. to decide to use this method over that method, or a combination of methods and medicines over that combination).

It’s understandable that marketers would want to advertise their product is ninety-some percent efficient without specifying exactly what that means. It’s disappointing that news sources pass along these numbers without explicating their meaning; especially since the technical reports are difficult and sometimes costly to obtain, as well as terse, jargon dense and nearly impossible for laypersons to read.

I do not wish to dissuade anyone from using whatever methods they deem effective for them. What is important is that people not be snowed or wowed by reports of high efficiency without knowing exactly how those numbers apply to their specific circumstances.

[Westheangelino]

^ Everyone who gets a scrip for this has to be counseled by a Dr., has to be tested for HIV AND monitor their kidneys every three months. Trust me, anyone who starts receiving this drug will get the proper facts. The real problem is that most of the people in the communities most affected by HIV in this country (poor black and brown folks) don't even know it exists yet, because it has not made its way into the mainstream consciousness, precisely due to the moralizing of groups like the AHF.

[trish]

I don't want to trust you, I just want an accurate description of what the numbers you quote mean. If you don't know, then why do you find them so convincing?

[Westheangelino]

I'm not asking you to trust me. I'm asking you to trust the CDC, the WHO, the states of New York, Michigan, Washington, and the list keeps growing.

This article should answer your questions:

http://www.aidsmap.com/Overall-PrEP-.../page/2892435/

[The Piper]

the WHO

I saw them live in Liverpool last year.
Roger Daltrey still has a great voice.

[Tapatio]

Thalidomide was once approved and considered a wonder.

[Westheangelino]

^ And is still used to treat cancer. It's effects on pregnant women ushered in an era where drugs are studied more carefully.

Your point?

[trish]

Were you able to fill in the blanks of post #219 by reading that article. I wasn't. Clearly, I'll not find the information I seek here. I'll leave you to your job of waking up HA's members to the existence of Truvada.

[Westheangelino]

I’m not disputing the effectiveness of Truvada or arguing either way the people should or shouldn’t avail themselves of it. I just want to know what 90% efficient means. The lay-literature never seems to fill in all the blanks:

The study shows us that we can be ____ confident that if the drug is used by _____ participants whose exposure conditions are _____ and whose dosage is ____ every _____hours, then over ______month’s time ____ to ____ transmissions will have occurred.

Example: If we are 95% confident that 8 to 12 people of a group of 100 will test positive at the end of the year given that all were having daily sex an AIDS positive partner, and given that each person took no more or less than three doses of BrandX preventative a week, then can say with 95% confidence that under these circumstances BrandX is 90% effective.

Note, sample sizes are chosen to obtained the desired level of confidence. Because the sample size is always smaller than the actual population one can never have 100% confidence. Suppose one study suggests with 95% confidence that if BrandX is used 4 times a week (under the specifically described conditions), then there will be no transmissions. What that tells us is that the probability of no transmission over one year’s time (under the described conditions and at a 4 times a week dosage rate) is 0.95. Over a decade that would reduce approximately to a probability of 0.60, therefore giving the user a 40% chance of testing positive by the end of the decade.

Other phrases one finds in the lay-literature like “90 % reduced risk” just add more layers of confusion. How was the prior risk defined? What were the exposure parameters, what prior methods were being utilized to minimize transmission? Etc.

Let me try. But I'll note that your use of the term "AIDS positive" person makes me think that you have little to no knowledge of HIV/AIDS, how people become infected, and how it has been treated.

But, I'll humor you: NOT ONE PERSON IN THE STUDY WHO TOOK TRUVADA EVEN FOUR DAYS A WEEK BECAME INFECTED OVER COURSE OF 17 MONTHS. The only people who became infected either never took the medication or stopped taking it several months before infection. Furthermore, the study showed that those who were engaging in more risky behavior practiced better adherence to their recommended drug regimen of a pill per day.

NOTHING is 100% effective. But please keep in mind that THIS is the same drug that keeps HIV from replicating in those already infected, thus bringing their viral load down to the point of "undetecatability", thus making them nearly non infectious. Please extrapolate that to people who are not infected to begin with. The drug works. It has worked for 12 years. This is just another discovered use for it, bourn out by several and increasing studies.

[MrBest]

We have plateaued in our efforts to combat this endemic disease through condoms.

again, how can hiv penetrate latex?