1 State's Plan to Fight the AIDS Epidemic

New York has a bold initiative underway to significantly decrease the number of HIV cases diagnosed every year by identifying those most at risk of contacting the disease, and prescribing PrEP therapy using Gilead's (GILD) Truvada.

Todd Campbell
Todd Campbell
Jul 6, 2014 at 1:30PM
Health Care

The State of New York recently announced its bold plan to fight back against AIDS in a press release titled "Governor Cuomo Announces Plan to End the AIDS Epidemic in New York State." The goal is simple: make HIV so uncommon that the number of people diagnosed each year is as small as the number of people diagnosed with tuberculosis. New York's plan to effectively stamp out new cases of HIV is unique in a nation that has seen little change in the absolute number of people diagnosed with the disease during the past 20 years.

The state's trailblazing approach makes it a pioneer in building upon official guidelines issued in May by the Centers of Disease Control, or CDC, recommending the widespread use of Gilead's (NASDAQ:GILD) HIV drug Truvada as a pre-exposure prophylaxis, or PrEP, therapy. It's also likely to boost the use and adherence to drugs offered by a range of drugmakers including Gilead, Bristol-Myers Squibb (NYSE:BMY) and AbbVie (NYSE:ABBV)

Controlling the disease
New York's three-point plan aims to reduce the number of people diagnosed with HIV to a level below the number of people passing away annually from the disease by 2020. This plan includes actively finding those with the disease who have yet to be diagnosed, increasing the use of anti-HIV drugs for those who are already diagnosed, and expanding Truvada's use among those at risk of contracting HIV.

Accomplishing this plan requires far closer communication between the state and physicians, and a significant outreach program designed to educate individuals about Truvada's role in PrEP.

In trials leading up to Truvada's FDA approval in 2012, the drug reduced the chances of contracting HIV by up to 92%. Yet, despite that significant reduction, and sales of more than $750 million in the first quarter, Truvada is only now beginning to see widespread use -- thanks, in part, to the new CDC recommendations.

Source: CDC

If New York succeeds in identifying those most at risk for contracting the disease, and is able to get and keep them on Truvada, the state has a very good chance of building upon its already impressive track record. In the past 10 years, the number of people diagnosed each year with HIV in New York has fallen by 40%, an impressive statistic considering that the national rate hasn't budged from about 50,000 new cases per year.

Reaching the target
In order to achieve its goal, the state is casting aside onerous requirements for written consent to HIV testing in favor of the verbal consent that is typical for most other tests. New York has also orchestrated deals with drugmakers of widely used HIV medications, including Gilead, that represent 70% of the HIV treatment market.

Gilead markets a slate of HIV drugs, including Truvada, which combined, generate more than $9 billion a year in sales. While participating in New York's program will mean Gilead will receive less than the $14,000 annual price for Truvada, it's likely to mean thousands of new patients, and a chance to further establish the drug as a cornerstone of efforts to erase HIV nationally.

Bristol-Myers, the maker of Reyataz, an HIV drug with $344 million in first-quarter sales, and AbbVie, which markets Kaletra, an HIV treatment with revenue of nearly $200 million in the first quarter, have also agreed to price cuts with the state.

Fool-worthy final thoughts
In order to gain the maximum protection against HIV, patients prescribed Truvada will need to take the once-daily drug consistently and continuously for as long as they're at risk, and they'll need to follow up with physicians every three months for screening. That could pose challenges for the state in monitoring and maintaining adherence.

The stakes, however, for keeping at-risk patients on PrEP are high. New York estimates that, for every person it can keep from getting HIV, the state will save $400,000 on costs of care over their lifetimes. That has New York estimating that, by preventing 3,400 cases per year, it will save $317 million in health-care costs that it would otherwise spend without its aggressive plan.

If this plan succeeds, it'll be good news for investors -- Gilead, Bristol-Myers, and AbbVie will make more money for shareholders -- but more importantly, it'll be good for public health here in the United States as a model for other states as they take the offensive in the fight against HIV.