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Stopping HIV Without a Vaccine · What's Your Problem?

0:15
Speaker 1: Pushkin. So I'm curious in your own life when you
0:24
Speaker 1: first became aware of HIV and AIDS.
0:29
Speaker 2: Oh gosh, this is a great question to start interview.
0:35
Speaker 2: I am fifty I did one, so I do remember.
0:41
Speaker 2: I remember the first news stories as a you know,
0:44
Speaker 2: as a child. It's also been a driver of everything
0:49
Speaker 2: I've worked on and wanted to work on.
0:51
Speaker 1: I am also fifty one, coincidentally, and I you know,
0:56
Speaker 1: I vaguely remember the world before HIV and AIDS. I
0:59
Speaker 1: also remember, and I'm sure you remember this too, like
1:02
Speaker 1: coming of age at a time when if you got AIDS,
1:06
Speaker 1: you died, and you could get it from having sex.
1:09
Speaker 2: Uh.
1:10
Speaker 1: To me, that's the that's the big imprint it left
1:13
Speaker 1: on my own you know, narrowly, narcissistically on my own life.
1:17
Speaker 2: Yes, so much fear, right, so much, so much death,
1:21
Speaker 2: so much destruction, destruction of potential, and so much fear
1:27
Speaker 2: and surgainly for a generation to have fear and sex
1:32
Speaker 2: so coupled with each other, so intertwined. But it's always
1:38
Speaker 2: driven me to to to end HIV is to be
1:41
Speaker 2: able for you know, there to be a generation who
1:45
Speaker 2: didn't have that cloud of fear in their lives.
1:54
Speaker 1: I'm Jacob Goldstein and this is What's Your Problem, the
1:56
Speaker 1: show where I talk to people who are trying to
1:58
Speaker 1: make technological progress. My guest today is Jared Bayton. He's
2:03
Speaker 1: senior vice president in virology Achillead Sciences. Jared's problem is this,
2:09
Speaker 1: in a world without a vaccine, how do you prevent
2:11
Speaker 1: people from getting HIV. It's been clear for years that
2:17
Speaker 1: taking a daily pill dramatically reduces the risk of getting HIV,
2:22
Speaker 1: but as you'll hear, the vast majority of people who
2:25
Speaker 1: are at high risk for getting HIV just don't take
2:28
Speaker 1: a pill every day. Now, Jared and his colleagues are
2:32
Speaker 1: working on a new option, a drug called leni kapavir
2:35
Speaker 1: that you get as a shot once every six months.
2:39
Speaker 1: The drug has not yet been approved to prevent HIV,
2:42
Speaker 1: but there have been some really compelling results from a
2:45
Speaker 1: couple big clinical trials. There's a lot that's interesting in
2:48
Speaker 1: the show today, how medicine only works if it meets
2:51
Speaker 1: people where they are, and how what seemed like a
2:54
Speaker 1: big problem for Lena kapavir may turn out to be
2:57
Speaker 1: the key to its success. But we started with Jared's
3:00
Speaker 1: own career, which tracks a lot of the history of
3:02
Speaker 1: HIV and AIDS and the emergence of drugs that can
3:06
Speaker 1: prevent people from becoming infected. So when do you decide
3:10
Speaker 1: to make fighting HIV your career.
3:17
Speaker 2: When I went to graduate school and medical school, I
3:20
Speaker 2: was when I decided to work on HIV that I
3:22
Speaker 2: wanted to do health work that was meaningful to the world.
3:26
Speaker 2: That was that it was and it was immediately actionable.
3:30
Speaker 2: As a graduate student during medical school, I lived and
3:33
Speaker 2: worked on HIV prevention in Kenya. Obviously before there was
3:39
Speaker 2: medicine for prevention, and I remember very well, even before
3:44
Speaker 2: there was very good testing. I was a strain of
3:46
Speaker 2: thought at the time that testing was too scary to
3:50
Speaker 2: do because there was nothing to be done.
3:52
Speaker 1: Wow.
3:53
Speaker 2: I certainly had other doctors say that to me. I
3:56
Speaker 2: the hospital that I worked in Kenya, the only testing
4:02
Speaker 2: that was done was so people could stop spending money
4:04
Speaker 2: on their family members.
4:05
Speaker 1: Oh my god, So meaning, oh, don't spend any money
4:08
Speaker 1: on them. They have HIV, They're going to die. That's
4:11
Speaker 1: why they were doing the tests.
4:13
Speaker 2: Yeah, someone in the hospital extraordinarily sick. Let's do an
4:15
Speaker 2: HIV test. Okay, you can stop spending money. Jesus and
4:18
Speaker 2: then really importantly, I remember when medicines came. I remember
4:22
Speaker 2: when medicines came. I remember when I remember very well
4:25
Speaker 2: when the coffin makers who would work in the street
4:28
Speaker 2: outside the hospital start going out of.
4:30
Speaker 3: Business, the coffin makers, the coffin makers, yep, holy yahkah,
4:36
Speaker 3: which gosh, the Kenya's prevalence maybe at fifteen percent or
4:42
Speaker 3: something like that at some point, and it's.
4:44
Speaker 2: Not much lower to be able to see in that
4:50
Speaker 2: country and other countries what medicines can do. And that's
4:53
Speaker 2: actually that's what drove a lot of signs. I've always done,
4:56
Speaker 2: is HIV prevention and then HIV treatment, but making medicines
5:00
Speaker 2: that make a difference in people's lives, and like what
5:02
Speaker 2: good medicines did for HIV care here in the US
5:06
Speaker 2: where I live from, in many parts of Africa where
5:09
Speaker 2: I've worked, and how fundamentally transformed, how socially transformative, how
5:14
Speaker 2: something risked really destroying in fraction societies, and how good
5:20
Speaker 2: science was able to arrest that in averse.
5:23
Speaker 1: Then so okay, so that's what's happening, you know, around
5:28
Speaker 1: the turn of this century. And then there's this new
5:31
Speaker 1: idea that comes along after that right, and that is
5:35
Speaker 1: what if we can use these drugs to prevent people
5:38
Speaker 1: at high risk from getting HIV in the first place. Right,
5:42
Speaker 1: This idea called prep Where does that come from?
5:46
Speaker 2: So this idea of prep pre exposure, prople axis, you
5:48
Speaker 2: take a medicine. By having that medicine, your bloodstreams, your
5:51
Speaker 2: tissues or whatever, you if you expose to the virus,
5:55
Speaker 2: it doesn't take hold. Yeah, and the idea of propyle
6:00
Speaker 2: axis is not totally novel in infectious diseases. If you've
6:05
Speaker 2: ever traveled to a place with malaria, you've probably taken
6:07
Speaker 2: a malaria propyle axis that kind of idea, But they
6:11
Speaker 2: do prep for HIV was super surprising at the time.
6:15
Speaker 1: Huh.
6:15
Speaker 2: You have to have a medicine that would work to
6:18
Speaker 2: prevent HIV and HIV is very transmissible, so to avert
6:23
Speaker 2: infection would be a high bar. And then it has
6:26
Speaker 2: to be medicine itself that's very well tolerated, very safe
6:30
Speaker 2: because you're it would be given to healthy individuals who
6:34
Speaker 2: don't have affection, and the societal medical tolerance for side
6:38
Speaker 2: effects for treating HIV, just like treating any really serious
6:41
Speaker 2: dead latencies, is different than but for preventing.
6:44
Speaker 1: It, sure, it has to be lower risk. Right, if
6:46
Speaker 1: you already have HIV and you're going to die, you're
6:48
Speaker 1: willing to take a right medicine that has pretty severe
6:51
Speaker 1: side effects, whereas if you're healthy, you're not going to
6:55
Speaker 1: take some really harsh, risky drug just in case.
6:59
Speaker 2: Exactly exactly right and unfortunately for treating HIV. Just for
7:03
Speaker 2: your listeners, like the complexity and the side effects of
7:06
Speaker 2: the medicines from the late nineties and two thousand have
7:10
Speaker 2: changed dramatically in the last couple of decades, and so
7:12
Speaker 2: that most people these days actually take a single pill
7:16
Speaker 2: once a day, extremely well tolerated, and live what's expected
7:21
Speaker 2: to be a full lifespan lived as long as someone
7:23
Speaker 2: who doesn't have HIV and are on infections. So just
7:26
Speaker 2: so people know what's changing. But in early two thousands,
7:30
Speaker 2: medicine still had side effects.
7:31
Speaker 1: Were you working on PREP at this time?
7:33
Speaker 2: I worked on one of the two trials that formed
7:36
Speaker 2: the registrational package of PREP, one in mostly gave men
7:40
Speaker 2: and some transgender individuals, and then one in heterosexual individuals,
7:46
Speaker 2: women and men, And that was the second one was
7:49
Speaker 2: the study that I worked on with collaborators from all
7:51
Speaker 2: over the world. And based in Kenyan. You gotta it
7:54
Speaker 2: was almost five thousand couples where one person didn't have
7:59
Speaker 2: HIV and the other one did.
8:01
Speaker 1: So that's a very high risk setting, very.
8:03
Speaker 2: Higher setting, and also setting where there was tremendous motivation
8:07
Speaker 2: to have a different life experien for the couple it was.
8:11
Speaker 2: It was a really remarkable time because there was lots
8:13
Speaker 2: of questions where the park would work at all. There
8:15
Speaker 2: was not a question where it could be safe enough
8:17
Speaker 2: and go to the trials demonstrated both safety and HIV protection.
8:22
Speaker 2: Protection that was dependent on people taking it. Like all medicines,
8:26
Speaker 2: medicines only work if you take them, and there are
8:28
Speaker 2: all kinds of different motivations to take something, predict something
8:31
Speaker 2: that's every day, and some people really succeed and some
8:33
Speaker 2: people really struggle. As you can access.
8:36
Speaker 1: So you are, they're setting up the next turn in
8:40
Speaker 1: our story, which is the new drug we are here
8:43
Speaker 1: to talk about, right, But let's just do that for
8:48
Speaker 1: a minute more, because as you said that the drugs
8:52
Speaker 1: people can take to prevent getting HIV have gotten easier
8:56
Speaker 1: to take and better tolerated. And you know, if you
9:00
Speaker 1: can take one pill a day and you're in a
9:02
Speaker 1: high risk setting and that means you have a profoundly
9:05
Speaker 1: lower risk of getting HIV. Like, what's the problem? Like
9:09
Speaker 1: I feel like, great work, thank you for doing that
9:12
Speaker 1: good work, and like it seems like you're there.
9:18
Speaker 2: I'm sure there were moments where I thought, it seems
9:20
Speaker 2: like we're there. This seems obvious to me as well. Yeah,
9:23
Speaker 2: I remember well the first day. Its actually years after
9:28
Speaker 2: the first medication for PREP was approved, where it had
9:32
Speaker 2: never been something like this hadn't been rolled out in clinics,
9:37
Speaker 2: so like people doctors didn't have the conversation pieces to
9:41
Speaker 2: talk with this, patients or individuals who wanted PREP didn't
9:44
Speaker 2: always have heard about it or didn't have the practice
9:48
Speaker 2: and asking for it. And it was slow. It was
9:52
Speaker 2: slow going, slow going in this country, slow going around the.
9:55
Speaker 1: World, slow going meaning people just didn't take it that much.
9:59
Speaker 1: Healthy people didn't want to take a pill every day.
10:02
Speaker 2: Yeah, I was like, yes, this is hard, like new
10:04
Speaker 2: innovations and health are hard because none of us make
10:08
Speaker 2: health decisions, or at least I think most of us.
10:11
Speaker 2: Most of us do not make health decisions just because
10:13
Speaker 2: someone tells us to or because the science is really excellent.
10:17
Speaker 2: We make health decisions because we think it's going to
10:19
Speaker 2: be meaningful for us. So whether that's like what we
10:21
Speaker 2: eat or going to gym, or like what we buy
10:24
Speaker 2: off Instagram or whatever else for our health, Like, we
10:28
Speaker 2: make those decisions because we think it's meaningful for us.
10:30
Speaker 2: And something like PREP, which can be extorted and meaningful,
10:33
Speaker 2: it has to be extortedly meaningful for someone to want
10:35
Speaker 2: to make the effort to go to get it and
10:38
Speaker 2: to continue it. There are many many people who take
10:42
Speaker 2: PREP every single day. It fits into their lives. It
10:44
Speaker 2: brings benefit, and it brings meeting and they can make
10:47
Speaker 2: it workable within their lives. And then there have been
10:51
Speaker 2: many people who have tried and stopped or not tried
10:55
Speaker 2: at all. And that's like setting up for my rest
10:58
Speaker 2: for our discussion. Just because you have something that works
11:04
Speaker 2: for some people, that airing that bottle home or it
11:08
Speaker 2: could be found by an aunt, partner or brother or
11:12
Speaker 2: whatever is too much, too much disclosure, too much revealing.
11:20
Speaker 1: It means you're having sex, probably right, yeah.
11:23
Speaker 2: Exactly, Or the complexity of the of taking something every
11:27
Speaker 2: day when you've got two jobs and three kids or
11:31
Speaker 2: whatever the things are that for something that you don't
11:35
Speaker 2: really want to think about every day.
11:36
Speaker 1: Yeah, it's a very good qualitative description. Is there a
11:40
Speaker 1: quantitative piece like, have you estimated the population that you
11:44
Speaker 1: know might be relevant but doesn't want to take a
11:46
Speaker 1: pill every day in the first place.
11:48
Speaker 2: Yeah, In the US, CC is estimated that maybe about
11:52
Speaker 2: a third of the people who would most benefit from
11:54
Speaker 2: taking PREP, not even like benefit at all, but like
11:57
Speaker 2: most benefit from taking PREP are taking it sort of
12:00
Speaker 2: today we are taking it day to day.
12:02
Speaker 1: Wait, one third of the people who are at highest
12:05
Speaker 1: risk for getting HIV are taking it. So two thirds
12:08
Speaker 1: of the people are.
12:09
Speaker 2: Not exactly so, a third r a third arth, two
12:12
Speaker 2: thirds are not.
12:13
Speaker 1: So okay, So there is this idea that PREP is great,
12:19
Speaker 1: but most people who could most benefit from it don't
12:22
Speaker 1: take it. One thought as well, if instead of having
12:26
Speaker 1: to take a pill every day, it was less frequent,
12:30
Speaker 1: simple behavioral thing, maybe people would do it more often.
12:32
Speaker 1: And so so there's this search for a for a
12:35
Speaker 1: new drug that is longer lasting, right, that you in
12:37
Speaker 1: fact have found spoiler alert, But tell me about the
12:41
Speaker 1: search for that drug.
12:42
Speaker 2: The idea was that HIV has a structural element called
12:47
Speaker 2: it's capsid, where it encloses the nucleic acid of the
12:50
Speaker 2: virus within the virus.
12:52
Speaker 1: It's it's like it's the bag, right, It's the protein.
12:54
Speaker 2: It's yeah, it's a protein coming. It's like a yeah.
12:58
Speaker 2: And I always want to think it's stronger than the bag.
13:00
Speaker 2: It's stronger than a bag.
13:02
Speaker 1: It's like okay, it like akayas case flask okay, okay.
13:07
Speaker 2: And that's the virus is coming into the cell that
13:09
Speaker 2: opens and dumps the new class ass and out. So
13:11
Speaker 2: the virus is infecting and when it leaves it encapsulates
13:14
Speaker 2: the begin and floats away. And targeting that is particularly hard,
13:18
Speaker 2: and the work on it began a dozen years before
13:22
Speaker 2: took a dozen years from the work to start before
13:25
Speaker 2: we've even tested any human being for the first time,
13:28
Speaker 2: and four thousand molecules were synthesized and screened in test
13:34
Speaker 2: tubes and animals, selling them other things to be able
13:36
Speaker 2: to be able to bring forward one to be able
13:38
Speaker 2: to test in human beings, which then became a lot
13:41
Speaker 2: of capeer.
13:45
Speaker 1: We'll be back in a minute.
13:56
Speaker 2: A virus like HIV has a certain number of proteins
13:59
Speaker 2: that make it function right and caps it had not
14:03
Speaker 2: been targeted and as a result of a great question
14:06
Speaker 2: to say, could we target this part of the virus
14:08
Speaker 2: in a way that it's different. This is important for
14:11
Speaker 2: HIV broadly because what has been the success of treating
14:16
Speaker 2: HIV is being able to target the virus in multiple places,
14:20
Speaker 2: in multiple components of its life cycle, and that is
14:24
Speaker 2: what makes up a treatment cocktail for HIV. Multiple medications
14:29
Speaker 2: usually the target different parts of the virus life cycle
14:32
Speaker 2: at the same time, and from a safety point of view,
14:35
Speaker 2: actually ones that are very specific to the virus itself
14:38
Speaker 2: and don't have effects on us. And so a enzyme
14:43
Speaker 2: that only the virus makes, or in this case, protein
14:46
Speaker 2: protein interaction that only the virus has, is a great
14:48
Speaker 2: target because there's nothing that looks like that in our
14:54
Speaker 2: regular systems.
14:56
Speaker 1: So basically that means people are likely to have fewer
14:58
Speaker 1: side effects because our own cells aren't gonna be bothered.
15:02
Speaker 1: So it seems like a promising target because it's this
15:04
Speaker 1: weird thing that the virus does that we don't do.
15:07
Speaker 1: And then drug researchers find this, this molecule, right, this
15:11
Speaker 1: potential drug that will eventually be called len.
15:14
Speaker 2: A cap of bear.
15:15
Speaker 1: But but there's what seems like a problem with this
15:18
Speaker 1: with this molecule, right, and the problem is that it's
15:21
Speaker 1: not very soluble in water. It doesn't dissolve well in water.
15:26
Speaker 1: Tell tell me about that part of it.
15:28
Speaker 2: There people who work on it. Just sometimes you do
15:31
Speaker 2: a lot of work to try to figure out the
15:33
Speaker 2: best what's got the best attack on the virus itself
15:36
Speaker 2: around the end time you're trying to target itself. And
15:38
Speaker 2: then it's not particularly soluble problem because that like medicines
15:42
Speaker 2: that we take through our mouth, for example, like most
15:45
Speaker 2: medicine surge IVY need to dissolve an order for us
15:49
Speaker 2: to absorb them. And actually a lot of work goes
15:52
Speaker 2: into one one's doing drug development, and maybe you figure
15:55
Speaker 2: out the thing that targets best, and then you figure
15:56
Speaker 2: out how to modify it ever as best you can
15:59
Speaker 2: to be able to absorb it, because if you can't
16:01
Speaker 2: absorb it doesn't have an effect.
16:02
Speaker 1: Right you want you want it to dissolve in water.
16:05
Speaker 1: You want to take it and then it dissolves and
16:08
Speaker 1: goes off into your correct exactly.
16:11
Speaker 2: It's the tremendous advantage of Lena kaeper beer has been
16:16
Speaker 2: for what it eventually became is that when it's formulated
16:21
Speaker 2: as an injection, it forms a deepot of the drug,
16:25
Speaker 2: well deposit of the drug that dissolves slowly over time
16:28
Speaker 2: because it isn't immediately soluble.
16:31
Speaker 1: And like, was there a moment when somebody sort of
16:34
Speaker 1: just realized like, oh, this this bug could actually be
16:37
Speaker 1: you know, like an amazing feature. You know the fact
16:40
Speaker 1: that it's not soluble, like it might mean we could
16:42
Speaker 1: give this drug to people and it would last a
16:44
Speaker 1: really long time.
16:46
Speaker 2: I don't think that there's an exact moment. I think
16:47
Speaker 2: there's actually many moments along the way or a discovery
16:51
Speaker 2: like this, it's what do we have? How do we
16:54
Speaker 2: improve on that? Where could we get to? And I
16:56
Speaker 2: think the I will tell you the very first testing
16:59
Speaker 2: of lena caprier was not a six month injection.
17:02
Speaker 1: So over time, a lot of whiteboards, a lot of
17:04
Speaker 1: rooms full of people, you get to this idea of oh,
17:07
Speaker 1: we could do this as an injection that lasts four
17:10
Speaker 1: months and months.
17:11
Speaker 3: Right.
17:11
Speaker 2: Yeah.
17:12
Speaker 1: So there's two big sort of pivotal trials that you run, right,
17:16
Speaker 1: tell me about them.
17:17
Speaker 2: It's actually an entire program called Purpose And there are
17:20
Speaker 2: two trials, Purpose one in Purpose two.
17:23
Speaker 1: What's the acronym you say, Purpose? I got to ask
17:25
Speaker 1: you for the acronym.
17:26
Speaker 2: Oh, no, so the actually that acronym really is really complicated.
17:31
Speaker 2: It is not a clear pee you are, so, yeah, no, yeah,
17:36
Speaker 2: I don't make these up. But the trials are run
17:39
Speaker 2: across five continents, thousands of people, almost ten thousand people
17:44
Speaker 2: in total. And the two trials Purpose one and two
17:48
Speaker 2: were the trials that specifically are phase three pivotal trials
17:53
Speaker 2: for testing whether something is safe and effective.
17:56
Speaker 1: And what were the results?
17:58
Speaker 2: Yeah, so Purpose one is among Allison girls and young
18:03
Speaker 2: women in South Africa Uganda. It's almost five thousand people
18:08
Speaker 2: in the trial who were either taking the daily pill
18:11
Speaker 2: or taking the injection. And the among people who were
18:14
Speaker 2: assigned the injection, zero infections occurred for the primary d
18:17
Speaker 2: priant of the trial, which had never been seen before
18:19
Speaker 2: for an HIV prevention trial.
18:21
Speaker 1: So okay, so zero absolutely no. One of the two
18:26
Speaker 1: thousand or so people who got lenni kapavir, none of
18:29
Speaker 1: them got HIV in the control group. So they were
18:32
Speaker 1: taking in the control group of the anti retroviral pills
18:36
Speaker 1: that are standard. Now, how many of those people got HIV.
18:40
Speaker 2: For people who are getting the control pill, which is
18:44
Speaker 2: active prep, the approved active crap, sixteen out of about
18:48
Speaker 2: one thousand.
18:51
Speaker 1: So sixteen out of a thousand is kind of a lot.
18:53
Speaker 1: This is like over the course of what a year.
18:54
Speaker 2: Or something about a year a year follow and in
18:59
Speaker 2: almost all the cases of the sixteen it's because invested
19:03
Speaker 2: blood samples from those individuals they weren't using it, and
19:07
Speaker 2: a testament to for some people how challenging it can
19:11
Speaker 2: be to use something every day and how something that
19:15
Speaker 2: injection twice a year for many people both could be
19:19
Speaker 2: very effective, but also is something that they can make
19:23
Speaker 2: workable because you can set it and not think about.
19:26
Speaker 1: It, Okay, forget it. What's the other What was the
19:31
Speaker 1: result of the second pivotal trial.
19:34
Speaker 2: Yeah, the second pivotal trial was the more geographically diverse
19:38
Speaker 2: group and was men, transgender women, and men and gender
19:41
Speaker 2: non binary people in Asia, North and South America and Africa.
19:45
Speaker 2: It's really broad and global. Yes, And in that study,
19:50
Speaker 2: again among about two thousand people, there were only two
19:52
Speaker 2: infections that occurred compared to nine infections among about a
19:58
Speaker 2: thousand people who received the control so also quite a difference.
20:03
Speaker 1: Yes, I mean, presumably the larger audience or the larger
20:07
Speaker 1: patient population is the people who aren't taking oral prep
20:09
Speaker 1: at all. Precisely, and you can't randomize ethically to that.
20:13
Speaker 1: You can't have a control group where it's like we're
20:15
Speaker 1: not going to give them anything and we're going to
20:16
Speaker 1: see how they do. But in real life, that is
20:19
Speaker 1: probably the population you're looking for.
20:21
Speaker 2: Right exactly.
20:22
Speaker 1: So okay, congratulations on the successful outcome of the trials.
20:27
Speaker 1: Where are you now?
20:29
Speaker 2: Oh so you know, bigger mind we talked about before.
20:32
Speaker 2: You know, just because science can be the science may
20:35
Speaker 2: be fantastic, you may have a great publication or a
20:39
Speaker 2: great p value for science, it doesn't mean that people
20:41
Speaker 2: actually get medicine. And so the medicine when the cover
20:44
Speaker 2: has been submitted to regulatory agencies, because drug approvals.
20:48
Speaker 4: Are a necessary step for people to receive them, and
20:52
Speaker 4: that rigorous process is ongoing now and regulatory parentcies all
20:57
Speaker 4: around the world.
20:58
Speaker 2: From the beginning, the thought has been for loutic cover
21:01
Speaker 2: that's a medicine that can have a global impact, and
21:05
Speaker 2: then readying for being able to make it and distribute
21:10
Speaker 2: it for people all around the world. As we have
21:12
Speaker 2: been doing all of those steps, the dissemination of the science,
21:15
Speaker 2: the regulatory submissions, we've been simultaneously making plans for global
21:21
Speaker 2: access particularly access for low and lower middle income countries,
21:24
Speaker 2: and that part of the story is as important as
21:26
Speaker 2: everything else because success for ending HIV is it has
21:31
Speaker 2: to be a global success.
21:32
Speaker 1: Yeah, so let's talk about that. I mean, there's obviously
21:35
Speaker 1: an interesting history of getting HIV drugs to lower income
21:41
Speaker 1: countries that largely has been a success. Right, people don't
21:44
Speaker 1: talk about it that much anymore, but it's a good,
21:47
Speaker 1: happy story. Ultimately, what's happening with Lena kapavir that in
21:52
Speaker 1: that context, Yes, the the.
21:55
Speaker 2: You know, we talked back about my earlier history and
21:57
Speaker 2: I remember well when there were no medicines in lower
22:00
Speaker 2: middle income countries and then when there was, and that
22:04
Speaker 2: was a delay of years and years. And that's not
22:07
Speaker 2: unique to HIV. That is for innovations and health in general,
22:10
Speaker 2: that it can take years or decades for medicines to
22:14
Speaker 2: make it from when they're discovered to even approval and
22:19
Speaker 2: then availability in low income countries. For lenikapavier years ahead
22:26
Speaker 2: of results, truly years ahead before we had results. We
22:29
Speaker 2: were thinking about how we can compress that calendar, and
22:35
Speaker 2: that included within weeks of the Purpose trials reading out
22:40
Speaker 2: an announcement that we'd signed voluntary license agreements which are
22:44
Speaker 2: which allow a generic manufacturer to make a version of
22:47
Speaker 2: the medicine. So would volntarize de agreees with six generic
22:50
Speaker 2: manufacturers covering one hundred and twenty countries low and lower
22:56
Speaker 2: mediome countries to be able to make generic versions in
22:59
Speaker 2: the medicines royalty free and no profit real that as
23:02
Speaker 2: soon as they're able to, so as soon as they
23:05
Speaker 2: can ramp up their technical capacity to be able to
23:08
Speaker 2: make these medicines.
23:10
Speaker 1: So it will be cheap for people in four parts
23:13
Speaker 1: of the world. And what does that mean sub Saharan Africa,
23:16
Speaker 1: parts of Asia exactly? What about well, what's it going
23:20
Speaker 1: to cost in the US? And how does how does
23:22
Speaker 1: like insurance work for PREP? Insurance cover PREP.
23:25
Speaker 2: So insurance dots cover PREP in the United States. And
23:28
Speaker 2: the CDC has done really extensive analysis yes, to summarize
23:34
Speaker 2: a lot of really good signs there their conclusions that
23:36
Speaker 2: access to PREP is not limited by insurance coverage, that
23:40
Speaker 2: there are two thirds of people who could most benefit
23:43
Speaker 2: using PREP. That's not for insurance reasons, that is for
23:45
Speaker 2: all kinds of the other reasons that we talked about
23:47
Speaker 2: of stigma and and I think that's a strategy looking
23:49
Speaker 2: forward to to len ACAFA. It's not proved yet United States,
23:52
Speaker 2: so there's not both insurance coverage and other things are
23:56
Speaker 2: not said yet. Those don't happen until the FDA is
23:59
Speaker 2: able to do their rigorous assessment about the efficating and
24:03
Speaker 2: safety of the medicine.
24:04
Speaker 1: So, Okay, you've been working on HIV for for a
24:07
Speaker 1: long time now, right for deaths, And I'm curious when
24:10
Speaker 1: you sort of take the long view and you step back,
24:14
Speaker 1: what do you see?
24:15
Speaker 2: Oh, you know, I have been doing this for a
24:18
Speaker 2: long time, and what has always motivated me is you
24:23
Speaker 2: know it is actually ending the epidemic.
24:25
Speaker 1: When you say ending the epidemic, I mean like I
24:28
Speaker 1: think of a vaccine and a global eradication campaign. Is
24:32
Speaker 1: that what you mean when you say that.
24:34
Speaker 2: I want to stop new infections. I want to be
24:36
Speaker 2: able to stop my infections as much as we can.
24:38
Speaker 2: I want to have treatments that are availed to every
24:42
Speaker 2: person living with HIV that allow them to live a
24:44
Speaker 2: full life, and as a result, turning off the tap
24:47
Speaker 2: of new infections, treating effectively the infections that are existing,
24:52
Speaker 2: then the public health emergency diminishes, and the cloud that
24:59
Speaker 2: is ACHIV on the world.
25:04
Speaker 1: We'll be back in a minute with the lighting round.
25:16
Speaker 1: You have undergraduate degrees, as I understand it, in both
25:19
Speaker 1: biochemistry and comparative religion. Which religions did you compare in
25:24
Speaker 1: which one.
25:24
Speaker 2: One one one?
25:28
Speaker 1: Which one lost?
25:30
Speaker 2: Now I have an undergraduator in comparative religion, which I love.
25:33
Speaker 2: I love the interface of society and health, society and
25:37
Speaker 2: person of religion. Degree was a great way to get out.
25:41
Speaker 1: I mean, tell me one thing, like what were you
25:44
Speaker 1: actually interested in?
25:45
Speaker 2: What? What? Like?
25:45
Speaker 1: What like? Tell me one thing you learned in studying
25:48
Speaker 1: comparative religion.
25:50
Speaker 2: Oh, I don't many things in comparive religion. I loved.
25:55
Speaker 2: I love complicated religious texts on how societies have fought
25:58
Speaker 2: through mystery in the world. I loved American religions because
26:02
Speaker 2: there's so much variety in the United States and it
26:05
Speaker 2: reflects a lot of the energy of the US for
26:08
Speaker 2: you know, all different directions. I have dynamism of dynamism
26:13
Speaker 2: of religion, and what religion says about society like still
26:17
Speaker 2: influences my all of the stuff I do.
26:19
Speaker 1: Now, what's your second least favorite virus?
26:24
Speaker 2: Second least favorite virus?
26:26
Speaker 1: I'm assuming HIV is your least favorite.
26:29
Speaker 2: HIV is my well, HIV is my favorite book favorite.
26:32
Speaker 1: There's two ways to frame it, right, favorite or least favorite,
26:35
Speaker 1: kind of the same. What's the number two after HIV?
26:38
Speaker 3: Oh?
26:39
Speaker 2: Hmm? Flu? Like which one is? I want to like
26:42
Speaker 2: white from the world. Flu would be great, big impact,
26:46
Speaker 2: terrible viruses that would be like a Goola Marburg that
26:52
Speaker 2: we'd love to that I'd love to see remove the world.
26:56
Speaker 2: All the viral epatitis viruses there's multiples of them that
27:00
Speaker 2: have tremendous prevalence in the world and don't get as
27:03
Speaker 2: much attention but kill lots of people. Would be great
27:07
Speaker 2: to eradic it.
27:09
Speaker 1: How many papers have you co authored that quote, Tina Turner?
27:13
Speaker 2: Oh, the quote one, Yes, there's one. There's there's one
27:18
Speaker 2: with a what's love got to do with the title? Yes?
27:19
Speaker 2: Which is about it was about like the motivations to
27:21
Speaker 2: take prep right, the motivations to take prep are not
27:24
Speaker 2: simply because someone waged their finger at you and said
27:27
Speaker 2: take your medicine. Yeah. Love.
27:36
Speaker 1: Jared Baton is senior vice president in virology at Kilead Sciences.
27:42
Speaker 1: Just a quick note, we'll be off for the next
27:44
Speaker 1: few weeks on a planned hiatus.
27:46
Speaker 2: We'll be back soon.
27:47
Speaker 1: Today's show was produced by Gabriel Hunter Chang, edited by
27:51
Speaker 1: Lydia Jean Kott, and engineered by Sarah Buguer. I'm Jacob Goldstein.
27:55
Speaker 2: Thanks for listening.