May 13, 2016
This week, we look at a study that contends pre-exposure prophylaxis (PrEP) for people who inject drugs may cost $44 billion over 20 years, but only prevent 26,700 new infections. Another study provides insight into making gene therapy research more efficient. To beat HIV, you have to follow the science!
A computer model of the public health benefits and cost of providing PrEP to people who inject drugs (PWID) in the U.S. found that it would cost $44 billion over the next 20 years, while preventing 26,700 new HIV infections among this population. The research was published in the Annals of Internal Medicine.
The best approach to PrEP in PWID was identified as prescribing the only currently FDA-approved medication for this purpose, tenofovir/emtricitabine (Truvada), combined with frequent HIV screenings and a prompt initiation of antiretroviral therapy for those newly diagnosed. At current drug prices, that scenario would cost $253,000 per quality-adjusted life year (QALY) gained (a measurement used to evaluate how cost effective an intervention is for one year in perfect health).
In an accompanying editorial, Rochelle P. Walensky, M.D., M.P.H., cites $100,000 per QALY gained as the threshold for good economic value of a health care measure. The price of PrEP would have to fall by 65% when tenofovir is expected to become generic next year in order to reach that threshold, the model predicts.
Walensky believes that the 47,000 deaths from an overdose of street drugs recorded in 2014 are a more immediate and higher priority than preventing HIV in PWID, asking, "What good is preventing HIV if we do not first save that life at HIV risk?"
The DNA of a retrovirus, such as HIV, searches relatively long for a good spot in which to insert itself into the host cells DNA, but the insertion itself happens very quickly, according to a study published in Nature Communications.
Researchers used a prototype foamy virus (PFV) integrase model and molecular microscopy to follow the virus' journey along an average of 1,500 DNA base pairs before it inserted itself into the host DNA. Often the viral DNA abandoned the search and was never integrated into the host DNA.
"If we can understand why insertion doesn't occur more often, it might lead to new drugs that prevent retroviral infection," said Kristine Yoder, Ph.D., one of the study authors.
The search for a suitable insertion location took 2 to 3 seconds, but once a spot was found, it took only 0.47 seconds for the retroviral DNA to insert itself into the host DNA. The PFV moved along the host DNA in a one-dimensional rotation-coupled diffusion pattern, which the press release about the study described as "like a nut on a bolt."
Because gene therapy uses viral vectors, and thus DNA search and insertion processes, the study's findings "might help make that process more efficient," Yoder hoped.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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