Well, epidemiologist and virologists accept that side effects balance very well given the alternative. Most men who take Truvada as PrEP only use it for a few years at the most. If they became infected with HIV, they’d have to take Truvada for the rest of their life, in combination with two other drugs, and even more side effects.
Although — did you know that people living with HIV who are in treatment with the full three-drug cocktail have been seen to enjoy a slight boost in life expectancy? Researchers speculate (the phenomenon hasn’t been fully studied yet) that the boost is a result of more frequent contact with health care providers due to mandatory blood testing for the meds regimen. So, things like cancer and cardiac problems get spotted earlier and sometimes nipped in the bud.
From a population point of view, Truvada doesn’t have a downside. The benefits of stopping HIV circulation vastly outweigh any risk.
From a personal point of view, everyone has to decide what their own risk factors are. I don’t use PrEP, for example. I’m not very sexually active anymore (I’m pushing 60), and I trust that I know what I’m doing with condoms and specific sex acts.
But if I were a young man again and clubbing again, I would definitely be taking Truvada. I know all too well that slip ups happen. I lucked out in the 80s and 90s, even though I was fully empowered with knowledge about safer sex. Sometimes condoms break. Sometimes we don’t use them quite right. And sometimes we get carried away in the heat of the moment.
If condoms were enough to stop the spread of HIV, we would have accomplished it by now. We wouldn’t be seeing stubbornly stable levels of new infections. But we are.
The only places we’re seeing HIV circulation stop in its tracks are places where we push Truvada hard in at-risk populations.
And btw, pharmaceuticals are looking hard for cures, but virologists aren’t optimistic for the near term. An HIV cure is super hard. Vaccines might be even harder.
But if we can strangle circulation with PrEP, we can still eliminate tremendous amounts of human suffering. And, btw, without effective circulation, there wouldn’t be any more need to sell Truvada.
So, the financial incentives really all come out in the wash.