A new drug for AIDS prevention has been approved in China. Can it become the “AIDS terminator”?

Recently, new AIDS prevention drugs, Napavir tablets and Lenapavir injection, were approved for marketing in China, claiming to be "100% effective in preventing" and to be the "terminator" of AIDS. Is it really that powerful?

First of all, this is a good thing, but it is not exaggerated to the point of becoming a "terminator", especially since the current HIV/AIDS transmission model in my country is still quite different from that in other countries, so we should not be overly optimistic. Let's talk about it below.

01There is a new treatment for AIDS

First of all, the approval of Napavir Tablets and Lenapavir Injection provides new means for the prevention and treatment of AIDS, which is very helpful.

Research data show that lenapavir can effectively reduce the risk of HIV infection and improve the effectiveness of HIV treatment. So from this point of view, it is better to have more prevention and treatment strategies for AIDS.

Next, let’s focus on this misunderstanding: “100% effective” and “terminator”

02 Is the new drug the “AIDS terminator”?

Many advertisements directly use the terms “100% effective” or “AIDS terminator”, which is extremely irresponsible.

1. It is not 100% effective. First of all, the research data of this drug itself has already said that it is not 100%. For example, in a double-blind experiment, 2 patients were unfortunately infected with AIDS among 2,180 participants , which shows that it is not 100%. Don't underestimate this one thousandth ratio. Put it in a large population, this data is very scary.

The current overall HIV infection rate in my country is only one in a thousand (as of June 30, 2024, a total of 1,329,127 living HIV-infected people and AIDS patients were reported in 31 provinces (autonomous regions and municipalities) across the country).

2. Population differences need to be considered . This is a very important reality. Although AIDS has multiple transmission routes, such as blood, mother-to-child transmission, sexual intercourse, etc., the transmission of AIDS in different places shows significant differences. Let's take China and the United States as an example.

03 The infection routes vary greatly

The infection routes vary greatly, especially for the neglected heterosexual group. Yes, here we want to focus on the neglected heterosexual group, because in recent years, a lot of propaganda and people's daily discussions have easily associated AIDS with the homosexual group. However, this is different in our country.

In the United States, according to the CDC, 70% of new HIV infections occur among gay and bisexual men.

The second largest group is heterosexuals (23%), and the third largest group is drug injection (9%).

But in China, this data varies greatly.

In my country, the main way of HIV transmission is sexual transmission, and 95% of new HIV infections are caused by sexual transmission. However, there are differences in the specific process. In my country, heterosexual transmission is the main way, accounting for 70%, while homosexual transmission is about 30%.

This is something that is very worthy of our attention. Infectious diseases must take into account the situation of the infected population, which is also a requirement of the three elements of infectious diseases.

Compared with homosexual transmission, it is more difficult for heterosexual transmission of AIDS. The risk of heterosexual transmission is 0.3%, while the risk of gangbang transmission is as high as 1.4%-1.7%. Under such circumstances, my country has the highest proportion of heterosexual transmission, which means that my country's transmission method is very unique and needs to be paid close attention to. In particular, current research shows that protective measures are very critical, which can be seen from different levels of economic development.

In low-income countries, the risk of female-to-male transmission per act is estimated at 0.38% and the risk of male-to-female transmission per act is estimated at 0.30%;

The corresponding estimates for high-income countries are a female-to-male transmission risk of 0.04% per act and a male-to-female transmission risk of 0.08% per act.

One reason is that although protective measures such as condoms are already very cheap, they are still a consideration for low-income countries.

At present, our country is paying close attention to the homosexual group, especially with all kinds of propaganda on the Internet. As a result, the homosexual group is paid attention to, but the heterosexual group may be ignored, resulting in it becoming a high-risk group .

04 Age distribution of infected groups

This is also very important. In the United States, the main group infected with AIDS is young people aged 20-29, with the highest rate and then decreasing with age.

However, in China, a new change has emerged in recent years, that is, middle-aged and elderly people over 45 years old are suffering from AIDS.

The AIDS population in my country is currently showing a two-way rise in the phenomenon, and the infection of middle-aged and elderly people is a very scary new trend.

In 2017, the number of AIDS cases among the elderly population in my country exceeded the proportion of AIDS cases among young people for the first time.

By 2019, the number of people suffering from AIDS among the elderly aged 50 and above accounted for 45.80% of all age groups.

"The elderly have become the group with the highest annual growth rate of HIV infection in China"... and the elderly and young people present two modes of sexual transmission.

Young people are mainly homosexual

Elderly people are mainly of the opposite sex

As for the middle-aged and elderly, AIDS did not exist or was only a minority during their growth period, and it was even still mainly transmitted through blood. Moreover, their ability to accept new knowledge is much lower than that of young people, and it is also very complicated for them to use drugs. This means that even if AIDS drugs are available, it is still a very distant thing for them.

05 Ethnic Differences

Although various ethnic groups were selected in clinical trials of lenapavir, the data are still small.

The difference in HIV transmission among different groups of people is a very real problem. Various data have found that HIV infection shows differences among different groups of people. Of course, this is related to the behavior of the groups of people, but whether there is a genetic influence behind it is also worthy of attention.

For example, CCR5△32, which was very popular in the past two years, is mainly found in the Nordic population, but is very rare in the Asian population.

Therefore, although lenapavir has shown good effects at present, it is worth paying attention to how much the efficacy will be discounted when it is used on a larger scale.

06 Compliance and Price

Patients often need to take medication for a long time, but for many people, one of the major obstacles to long-term medication is medication compliance, or in layman's terms, not following the doctor's orders. This is not only true for AIDS, but also for some very basic drugs such as calcium tablets.

Not to mention, this drug is expensive.

In short, it is a good thing to have new drugs, but don't over-publicize them, because for a disease like AIDS that is mainly transmitted through sexual transmission, it is more important to control and protect people from the perspective of transmission.

Condoms are currently the most cost-effective AIDS prevention measure.