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WELCOME TO THE CLINICAL
CENTER GRAND ROUNDS,

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A WEEKLY SERIES OF EDUCATIONAL
LECTURES FOR PHYSICIANS AND

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HEALTH CARE PROFESSIONALS
BROADCAST FROM THE CLINICAL

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CENTER AT THE NATIONAL
INSTITUTES OF HEALTH IN

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BETHESDA, MD.

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THE NIH CLINICAL CENTER IS THE
WORLD'S LARGEST HOSPITAL TOTALLY

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DEDICATED TO INVESTIGATIONAL
RESEARCH AND LEADS THE GLOBAL

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EFFORT IN TRAINING TODAY'S
INVESTIGATORS AND DISCOVERING

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TOMORROW'S CURES.

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LEARN MORE BY VISITING US ONLINE
AT HTTP://CLINICALCENTER.NIH.GOV

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GOOD AFTERNOON AND WELCOME TO

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TODAY'S CLINICAL CENTER GRAND

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ROUNDS.

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THE HOPKINS CLOUD CME ACTIVITY

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CODE, -- I'M TONGUE TIED TODAY

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SO YOU WILL HAVE TO FORGIVE ME

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HERE -- THE CME ACTIVITY CODE

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TODAY FOR TODAY'S GRAND ROUND

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SYSTEM 57877.

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PLEASE TEXT THIS CODE TO JOHNS

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COP KINS CME PHONE NUMBER ON

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THIS SLIDE TO RECEIVE CME CREDIT

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FOR THIS LECTURE.

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WE KINDLY INVITE YOU TO PROVIDE

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FEEDBACK ON THIS LECTURE BY

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SCANNING THE QR CODE SHOWN ON

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THE SLIDE.

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FOR THOSE APPLYING FOR CME, YOU

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WILL RECEIVE A FEEDBACK FEEDBACK

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LINK VIA E-MAIL EMPLOY THE

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SURVEY WILL BE PROVIDED WITH

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IMPORTANT FEEDBACK ABOUT THIS

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PRESENTATION AND ALLOWS TO YOU

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SUBMIT ANY SUGGESTIONS ARE GRAND

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ROUNDS TOPICS.

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FOLLOWING THE PRESENTATION,

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QUESTIONS FOR SPEAKERS WILL BE

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TAKEN FOR MICROPHONES IN THE

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AISLES.

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ADDITIONALLY VIDEOCAST VIEWERS

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MAY SUBMIT THOSE ANYTIME DURING

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THE LECTURE BY SCROLLING DOWN

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AND CLICKING THE LIVE FEEDBACK

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BUT LOCATED ON THE VIDEOCAST

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WEBSITE.

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QUESTIONS WILL BE ANSWERED AS

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TIME PERMITTINGS AT THE

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CONCLUSION OF THE PRESENTATION.

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TODAY WE ARE HONORED TO HAVE AS

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OUR SPEAKER DR. JEANNE,

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MARRAZZO, DIRECTOR OF THE

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PHYSICIAN SCIENTIST, INFECTIOUS

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DISEASE SPECIALIST.

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DR. MARRAZZO, EARNED HER

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BACHELOR ARTS FROM RAD CLIFF

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UNIVERSITY, MEDICAL DEGREE FROM

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JEFFERSON MEDICAL COLLEGE AND

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COMPLETE RESIDENCY IN INTERNAL

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MEDICINE AT YALE NEW HAVEN

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HOSPITAL.

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UPON HER TRAINING HE COMPLETED

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FELLOWSHIPS AT THE UNIVERSITY OF

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WASHINGTON AND A FELLOWSHIP IN

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STD, HIV PREVENTION PUBLIC

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HEALTH AND EPIDEMIOLOGY AT THE

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CENTERS FOR CONTROL AND

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PREVENTION AND LATEERA THE

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UNIVERSITY OF WASHINGTON.

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DR. MARRAZZO, BEGAN HER CAREER

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AT THE UNIVERSITY OF WASHINGTON

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RIDING TO BECOME PROFESSOR OF

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MEDICINE AND INFECTIOUS

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DISEASES, BEFORE JOINING FACULTY

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HER SCHOOL OF MEDICINE AT

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ALABAMA, AND ENDOWED SHARE AND

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DIRECTOR OF INFECTIOUS DISEASES

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IN 2016.

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IN TWEMENT 23, SHE WAS SELECTED

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AS THE SIXTH DIRECTOR AT THE

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NATIONAL INSTITUTE OF ALLERGY

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AND INFECTIOUS DISEASES.

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THE JOURNAL OF SCIENCE WRITES

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THAT DR. MARRAZZO, HAS

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ESTABLISHED HERSELF AS AN TREND

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SETTER, AND SHE LEADS PILLS AND

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VAGINAL GELS TO PREVENT

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INFECTION IN WOMEN. 

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SHE'S A NATIONALLY RECOGNIZED

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STD, PUBLICATIONS, AND

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UNDERSTANDING THE VAGINAL

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MICROBIOME STD INFECTIONS AND

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HIV PREEXPOSURE PROPHYLAXIS AND

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SHE'S HELD LEADERSHIP ROLES IN

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THE HIV PREVENTION TRIALS

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NETWORK AND INFECTIOUS DISEASE

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CLINICAL RESEARCH CONSORTIUM.

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A DISTINGUISHED SCIENTIST,

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CLINICIAN AND SCIENTIFIC

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COMMUNICATOR, DR. MARRAZZO IS A

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FELLOW OF THE AMERICAN COLLEGE

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OF PHYSICIANS AND FELLOW OF THE

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INFECTIOUS DISEASES SOCIETY OF

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AMERICA AND IS A LEADING VOICE

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AND WAS A LEADING VOICE IN

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COMMUNICATING SCIENCE DURING

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COVID-19 PANDEMIC.

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THE TITLE OF HER PRESENTATION

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TODAY IS CHEMO PROPHYLAXIS OF A

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SEXUALLY TRANSMITTED INFECTIONS

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IN HIV.

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NOW PLEASE JOIN ME IN WELCOMING

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OR SPEAKER DR. MAREFRESH  -- MA.

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>> THANK YOU VERY MUCH FOR
THAT

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KIND INTRODUCTION AND THANK YOU

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TO ALL OF YOU FOR BEING HERE

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TODAY BOTH IN-PERSON AND ONLINE.

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SO WHEN DR. BURKLOW, ASKED ME TO

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GIVE THIS PRESENTATION, HE

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INITIALLY ASKED ME TO TALK ABOUT

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DOCKS PSYCHE LYNN PROVE EXPOSURE

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PROPHYLAXIS WHICH MANY OF YOU

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KNOW OR WILL FIND OUT SOON WAS

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RECENTLY FORMALLY RECOMMENDED BY

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THE CENTERS FOR DISEASE CONTROL

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FOR THE PREVENTION OF CERTAIN

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STIs WHICH I WILL TALK ABOUT.

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I CAN'T THINK THERE WAS REALLY

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ENOUGH TO TALK ABOUT WITH

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DOXY-PEP FOR A WHOLE HOUR.

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SOME OF YOU MAY ARGUE WITH THAT.

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MAYBE IT'S MY DESIRE TO TALK

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ABOUT SOME OF THE REALLY

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EXCITING THINGS IN HIV

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PREVENTION, BUT I KEICIDED TO

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BROADEN IT A LITTLE BIT TO TALK

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ABOUT SOME OF THE MOST RECENT

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ADVANCES IN HIV PREVENTION.

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AND REALLY THE COMMON THREAD

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HERE IS THAT WE DON'T HAVE

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VACCINES FOR ANY OF THESE

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CONDITIONS, RIGHT?

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THE ONLY VACCINE THAT WE HAVE

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FOR SEXUALLY TRANSMITTED INFECTS

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BESIDES HEPATITIS B IS HUMAN

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PAPILLOMA VIRUS AND THAT'S BEEN

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A RESOUNDING SUCCESS DESPITE THE

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FACT THAT MANY PEOPLE REMAIN

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UNVACCINATED FOR HPV.

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SO WITH THAT, LET ME GO AHEAD

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AND GET STARTED.

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I WOULD LOVE TO HAVE THIS BE

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MORE INTERACTIVE, SO IF PEOPLE

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HAVE QUESTIONS OR THOUGHTS,

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PLEASE JUMP IN, I DON'T HAVE ANY

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CONFLICT ANDS I WILL DISCUSS

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DOXYPEP WHICH DESPIED CDC

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GUIDANCE IS NOT FDA APPROVED,

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THAT'S NEVER STOPPED ANYBODY

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FROM PRESCRIBING IT BUT JUST TO

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LET YOU KNOW ABOUT THAT.

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AND THE OBJECTIVE TO LOOK AT A

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CURRENT OVERVIEW OF THE PREAND

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POST EXPOSURE OF PROPHYLAXIS IN

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HIV AND STD, AND ESPECIALLY IN

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THE RECENT PURPOSE RESULT WHICH

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MANY OF YOU HAVE HEARD OF AND

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FOR INCREASING SUPPORT, BUT SOME

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CAVEATS FOR DOXY-PEP I HAVE TO

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SAY I WAS A DOXY-PEP PEP

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SKEPTIC, I AM A CAUTIONARY

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SUPPORT I REALLY OF DOXY-PEP AND

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DR. BENNETT MAY TOLD ME HE FEELS

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THE SAME BECAUSE HE TOLD ME HE

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HAS QUESTIONS SO I WILL GET HIS

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OPINION AS WE MOVE INTO THIS.

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THE QUESTION IS WHY ARE WE IN

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THIS STATE?

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AS I THINK MANY OF YOU HAVE

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HEARD ME SAY BEFORE, WE ARE

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LOSING THE WAR AGAINST SEXUALLY

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TRANSMITTED INFECTIONS WHETHER

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YOU'RE TALKING ABOUT VIRAL OR

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BACTERIAL, SEXUALLY TRANSMITTED

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INFECTIONS AND THE WHO 2024

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REPORT IS A VERY NICE IF

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SOBERING COMPENDIUM OF WHERE WE

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ARE WITH THESE INFECTIONS, I WAS

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REALLY SURPRISED TO SEE THAT IN

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2022, THERE WERE 220,000 CIVILIS

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ASSOCIATED DEATHS.

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IF YOU HAVEN'T SEEN A CIVILIS

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ASSOCIATED DEATH, I WOULD

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ENCOURAGE YOU TO THINK ABOUT

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THINGS LIKE NEUROSYPHILIS WHICH

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OFTEN GOES UNDIAGNOSED

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UNFORTUNATELY, ALSO CONGENITAL

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SYPHILIS WHICH I WILL SHOW YOU

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DATA ON IN A MINUTE WHICH IS

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REALLY SOBERING, SO A REALLY

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STAGGERING COST, AND IF YOU LOOK

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AT THE 4 CURABLE STIs THAT WE

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THINK ABOUT FREQUENTLY,

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SYPHILIS, GONORRHEA, CHLAMYDIA,

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AND TRICK MONITOR SIS, AND ALL

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WHICH ARE MAINLY CURABLE OFTEN

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WITH A SINGLE DOSE OF AN

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ANTIBIOTIC, THERE ARE OVER

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1 MILLION INFECTIONS DAILY.

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WE HAVE NOT CHANGED THIS SINCE

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THE DAYS I BEIMAN MY FELLOWSHIP,

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MANY, MANY YEARS AGO.

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SO IT REALLY HAS BEEN A -- I

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WOULD SAY A NEGLECTED FIELD,

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RELEVANT TO THE INVESTMENTS IN

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HIV, BUT WE'RE SORT OF PAYING

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THE PRICE FOR IT NOW.

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THE OTHER PROBLEM WITH GONORRHEA

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IN PARTICULAR AND I WILL SHOW

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YOU DATA ON THIS IS INCREASING

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ANTIMICROBIAL RESISTANCE.

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AND OF COURSE, THE HIV

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SITUATION, IS REALLY NOT THAT

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MUCH BETTER DESPITE SOME OF THE

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PROMISES THAT I'M GOING TO TALK

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ABOUT, WE STILL HAVE OVER

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1.3 MILLION NEW INFECTIONS OVER

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A YEAR, OVER 630,000 DEATHS AND

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OF COURSE THOSE OF YOU WHO DO

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CLINICAL WORK HERE KNOW WHO

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THESE NEW INFECTIONS ARE,

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THEY'RE OCCURRING IN VERY

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VULNERABLE POPULATIONS WHO OFTEN

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DON'T HAVE ACCESS TO SOME OF THE

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BEST PREVENTIVE MEASURES,

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LARGELY BECAUSE OF FINANCIAL

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ISSUES, IMMIGRATION ISSUES,

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STIGMA ISSUES, LOTS OF THINGS

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THAT INFORM INABILITY TO GET

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CARE AND JUST A REMINDER,

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SEXUALLY TRANSMITTED VIRAL

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HEPATITIS NOT TO BE DISCOUNTED

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DESPITE THE FACT THAT WE HAVE A

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VERY EFFECTIVE VACCINE FOR HEAP

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TITIS B, WE STILL HAVE

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1.3 MILLION DEATHS ASSOCIATE

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WIDE VIRAL HEPATITIS A YEAR, AND

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OF COURSE WE HAVE A CURATIVE

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REGIMEN FOR HEPATITIS C.

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I MENTIONED THE PROBLEM WITH

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SYPHILIS, ANYBODY SEEN A CASE OF

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CONGENITAL SYPHILIS IN THIS

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ROOM, IF YOU HAVE RACE YOUR

253
00:09:14,575 --> 00:09:16,077
HANDS, OKAY, SO NOT SO MUCH

254
00:09:16,077 --> 00:09:24,552
HERE, I SAW A CASE IN LIMO,

255
00:09:24,552 --> 00:09:26,854
ACTUALLY IN KUSCO, PERU NOT TOO

256
00:09:26,854 --> 00:09:31,692
LONG AGO BUT BEFORE WE I LEFT

257
00:09:31,692 --> 00:09:32,760
ALABAMA WE HAD 22 CASES FROM THE

258
00:09:32,760 --> 00:09:34,695
YEAR I LEFT AND THAT WENT UP

259
00:09:34,695 --> 00:09:38,699
FROM HAVING 0 EXPW WE WENT FROM

260
00:09:38,699 --> 00:09:41,135
HAVING 335 CASES IN 2012 TO OVER

261
00:09:41,135 --> 00:09:43,571
3700 LAST YEAR.

262
00:09:43,571 --> 00:09:46,307
THIS WAS ACCOMPANIED BY

263
00:09:46,307 --> 00:09:49,310
APPROXIMATELY 270 KNOWN FETAL

264
00:09:49,310 --> 00:09:50,645
DEATHS TUE TO THIS INFECTION.

265
00:09:50,645 --> 00:09:52,580
AND WHEN YOU LOOK AT WHY THIS IS

266
00:09:52,580 --> 00:09:56,117
OCCURRING, IT'S NOT JUST DUE TO

267
00:09:56,117 --> 00:09:59,554
AN INABILITY TO MAKE THE

268
00:09:59,554 --> 00:10:00,588
DIAGNOSIS CORRECTLY, IT'S ALSO

269
00:10:00,588 --> 00:10:01,923
DUE TO INCORRECT TREATMENT, AND

270
00:10:01,923 --> 00:10:03,891
THERE'S A VERY NICE OVERVIEW ON

271
00:10:03,891 --> 00:10:05,860
THE CDC WEBSITE THAT DEALT INTO

272
00:10:05,860 --> 00:10:09,330
THE REASONS FOR THIS WHICH RANGE

273
00:10:09,330 --> 00:10:10,798
FROM VERY DISENFRANCHISED PEOPLE

274
00:10:10,798 --> 00:10:13,301
WHO DON'T ACCESS PRENATAL CARE

275
00:10:13,301 --> 00:10:14,902
PARTICULARLY IN NATIVE AMERICAN

276
00:10:14,902 --> 00:10:16,971
AND AMERICAN INDIAN POPULATIONS,

277
00:10:16,971 --> 00:10:19,373
THE INCIDENCE IN THAT GROUP IS

278
00:10:19,373 --> 00:10:21,909
OVER  4

279
00:10:21,909 --> 00:10:23,311
TIMES RELATIVE THAT TO OTHERS.

280
00:10:23,311 --> 00:10:25,913
SO THIS A PROBLEM THAT GETS AT

281
00:10:25,913 --> 00:10:27,081
ALL THE VULNERABILITIES OF OUR

282
00:10:27,081 --> 00:10:31,319
HEALTHCARE SYSTEM IN THE UNITED

283
00:10:31,319 --> 00:10:32,119
STATES.

284
00:10:32,119 --> 00:10:35,356
THE SIN DEMICS OF LACK OF

285
00:10:35,356 --> 00:10:37,925
INSURANCE, LACK OF ACCESS,

286
00:10:37,925 --> 00:10:40,895
SUBSTANCE USE, MENTAL HEALTH,

287
00:10:40,895 --> 00:10:43,297
AND A LACK OF REPRODUCTIVE

288
00:10:43,297 --> 00:10:45,266
HEALTHCARE, FRANKLY, O IT'S A

289
00:10:45,266 --> 00:10:46,267
REALLY, REALLY BIG CHALLENGE.

290
00:10:46,267 --> 00:10:48,469
NOT GOING TO TALK ABOUT THAT

291
00:10:48,469 --> 00:10:50,004
MUCH TODAY, BUT I DON'T WANT TO

292
00:10:50,004 --> 00:10:53,674
LET IT GO BY TO POINT OUT THAT

293
00:10:53,674 --> 00:10:55,810
WE DO HAVE A LOT GOING ON IN

294
00:10:55,810 --> 00:10:59,914
THIS SPACE AND IF YOU HAVE SEEN

295
00:10:59,914 --> 00:11:03,351
OUR RECENT PRESS RELEASE FROM

296
00:11:03,351 --> 00:11:04,719
DMID, WE ANNOUNCED SEVERAL

297
00:11:04,719 --> 00:11:06,687
EFFORTS INCLUDING SOME RAPID

298
00:11:06,687 --> 00:11:08,456
POINT OF CARE DIAGNOSTIC

299
00:11:08,456 --> 00:11:08,689
STUDIES.

300
00:11:08,689 --> 00:11:10,791
THOSE OF YOU WHO DO CONSULTS,

301
00:11:10,791 --> 00:11:12,560
SPECIALLY IN THE HIV CARE

302
00:11:12,560 --> 00:11:15,396
SETTING, KNOW THAT SOME OF THE

303
00:11:15,396 --> 00:11:18,599
THORNIEST PROBLEMS YOU GET ON

304
00:11:18,599 --> 00:11:19,800
INTERPRETATIONS OF CIVILIS

305
00:11:19,800 --> 00:11:23,371
SERIES POINTSOLOGYYS, HOW DO YOU

306
00:11:23,371 --> 00:11:25,106
HANDLE SYPHILIS SERIES

307
00:11:25,106 --> 00:11:27,475
POINTSOLOGYS, IS SOMEBODY REALLY

308
00:11:27,475 --> 00:11:27,742
CURED?

309
00:11:27,742 --> 00:11:29,076
DOES SOMEONE HAVE SYPHILIS?

310
00:11:29,076 --> 00:11:30,544
ALL OF THESE ARE THE SAME

311
00:11:30,544 --> 00:11:31,479
PROBLEMS BECAUSE WE'RE DEALING

312
00:11:31,479 --> 00:11:32,513
WITH THE SAME SEROLOGIC TEST

313
00:11:32,513 --> 00:11:34,382
WHEN I WAS A FELLOW.

314
00:11:34,382 --> 00:11:35,616
YTION, THERE ARE BETTER WAYS TO

315
00:11:35,616 --> 00:11:38,152
DO IT, YOU YOU HAVE THE ENZYME

316
00:11:38,152 --> 00:11:39,654
IMOWN O ASSAY, BUT REALLY YOU'RE

317
00:11:39,654 --> 00:11:41,122
STILL DEALING WITH LOOKING AT

318
00:11:41,122 --> 00:11:42,923
THE SAME ANTIIENS AND SAME

319
00:11:42,923 --> 00:11:44,625
CHALLENGES, SO HOPEFULLY WE WILL

320
00:11:44,625 --> 00:11:47,161
BE ABLE TO GET SOME NEW

321
00:11:47,161 --> 00:11:48,295
THOUGHTS, NEW IDEAS AND GET

322
00:11:48,295 --> 00:11:51,732
THINGS OUT THERE, AND IF YOU TRY

323
00:11:51,732 --> 00:11:53,100
TO DIAGNOSE CONGENITAL SYPHILIS,

324
00:11:53,100 --> 00:11:54,068
THAT'S A REAL CHALLENGE, IF YOU

325
00:11:54,068 --> 00:11:55,536
LOOK AT THE FLOW CHART TO DO IT,

326
00:11:55,536 --> 00:11:58,973
YOU DON'T WANT TO GO NEAR IT,

327
00:11:58,973 --> 00:11:59,407
IT'S VERY CONFUSING.

328
00:11:59,407 --> 00:12:01,442
SO CIVILIS IS A BIG PROBLEM,

329
00:12:01,442 --> 00:12:04,545
GONORRHEA IS A VERY BIG PROBLEM,

330
00:12:04,545 --> 00:12:09,950
40% INCREASE IN THE EU, NATIONS

331
00:12:09,950 --> 00:12:13,421
OVER IN 2021 FROM 2022, AND THE

332
00:12:13,421 --> 00:12:17,925
RESISTANCE PROFILES CONTINUE TO

333
00:12:17,925 --> 00:12:18,325
BE VERY ALARMING.

334
00:12:18,325 --> 00:12:20,561
SWRIGHT ROUGH ATOM MICEIN YOU

335
00:12:20,561 --> 00:12:23,064
MAY RECALL AS 2012 WAS ADDED AS

336
00:12:23,064 --> 00:12:24,065
AN ADDITIONAL THERAPY FOR

337
00:12:24,065 --> 00:12:27,334
GONORRHEA, IT WAS ADDED TO

338
00:12:27,334 --> 00:12:28,936
SIEVEULOUS FOREIGN, THE THINKING

339
00:12:28,936 --> 00:12:33,774
THERE WAS THAT IT WOULD

340
00:12:33,774 --> 00:12:34,375
FORESTALL SOME ANTIMICROBIAL

341
00:12:34,375 --> 00:12:35,409
RESISTANCE AND AT THE TIME WE

342
00:12:35,409 --> 00:12:36,877
THOUGHT IT WAS MAGICAL THINKING

343
00:12:36,877 --> 00:12:38,145
AND IT WAS BECAUSE WHAT HAPPENED

344
00:12:38,145 --> 00:12:41,382
OF COURSE WAS THAT YOU ENDED UP

345
00:12:41,382 --> 00:12:42,783
DEVELOPING MORE SWRIGHT ROUGH

346
00:12:42,783 --> 00:12:45,619
ATOM MICEIN RESISTANCE AND IN

347
00:12:45,619 --> 00:12:46,454
PARTICULAR, IN PHARYNGIAL

348
00:12:46,454 --> 00:12:48,189
ISOLATES WHICH KIND OF MAKES

349
00:12:48,189 --> 00:12:48,389
SENSE.

350
00:12:48,389 --> 00:12:51,892
SO WE NOW ARE LOOKING AT ABOUT A

351
00:12:51,892 --> 00:12:55,963
QUARTER OF ISOLATES BEING FULLY

352
00:12:55,963 --> 00:12:59,967
RESISTANT TO 2 SWRIGHT ROUGH

353
00:12:59,967 --> 00:13:01,769
ATOM MICEIN, CIPROFLOCKS SIN CAN

354
00:13:01,769 --> 00:13:03,671
NOT BE USED THERE ARE NO QUINA

355
00:13:03,671 --> 00:13:05,773
LONES, IT'S A HIGH RATE OF

356
00:13:05,773 --> 00:13:06,607
RESISTANCE AND NOTABLY

357
00:13:06,607 --> 00:13:07,641
RESISTANCE IS MUCH HIGHER IN MEN

358
00:13:07,641 --> 00:13:08,642
WHO HAVE SEX WITH MEN.

359
00:13:08,642 --> 00:13:10,411
WE CAN TALK ABOUT THAT IF WE

360
00:13:10,411 --> 00:13:11,679
HAVE TIME, IT'S NOT REALLY CLEAR

361
00:13:11,679 --> 00:13:12,980
WHY THAT IS, THERE'S SOME

362
00:13:12,980 --> 00:13:15,850
THINKING THAT THERE MAY BE A

363
00:13:15,850 --> 00:13:17,451
HIGHER PREVALENCE OF PHARYNGIAL

364
00:13:17,451 --> 00:13:20,988
GONORRHEA IN THAT GROUP AND THAT

365
00:13:20,988 --> 00:13:23,724
THE ABILITY FOR PLASMA

366
00:13:23,724 --> 00:13:25,326
EXCHAIRVELG TO OCCUR WITH

367
00:13:25,326 --> 00:13:28,429
COMMENSAL GONORRHEA -- SORRY

368
00:13:28,429 --> 00:13:29,463
COMMENSAL NISERIES POINTSIOUS

369
00:13:29,463 --> 00:13:32,666
SPECIES MAY BE EXPOSED TO THAT.

370
00:13:32,666 --> 00:13:35,469
FORTUNATELY RESISTANCE TO

371
00:13:35,469 --> 00:13:37,972
CFIXIME REMAINS LOW, WE HAVE 1

372
00:13:37,972 --> 00:13:40,074
POPULATION WE CAN USE AT .3% BUT

373
00:13:40,074 --> 00:13:46,180
WELL IS CONTINUED DETECTION OF

374
00:13:46,180 --> 00:13:46,814
OCCASION CEFTRIAXONE RESISTANCE

375
00:13:46,814 --> 00:13:48,315
AND I WILL SHOW YOU THAT IN A

376
00:13:48,315 --> 00:13:49,049
COUPLE SLIDES IN A SECOND EMPLOY

377
00:13:49,049 --> 00:13:52,586
SO LET'S SHIFT TO THINKING ABOUT

378
00:13:52,586 --> 00:13:55,356
HOW YOU MIGHT USE DOXY-PEP

379
00:13:55,356 --> 00:13:58,926
PSYCHE LYNN FOR SOMETHING LIKE

380
00:13:58,926 --> 00:14:01,562
SYPHILIS, GONORRHEA AND

381
00:14:01,562 --> 00:14:06,000
CHLAMYDIA, WHEN WE TARTED

382
00:14:06,000 --> 00:14:08,435
TALKING ABOUT DOXY-PEP PSYCHE

383
00:14:08,435 --> 00:14:09,436
LYNN, THE BIG SPRRN WAS THAT WE

384
00:14:09,436 --> 00:14:11,739
WERE GOING TO DRIVE THE INCREASE

385
00:14:11,739 --> 00:14:14,575
IN EABT BI ATTIC RESISTANCE IN

386
00:14:14,575 --> 00:14:18,179
GONORRHEA SIMPLY BY GETTING THIS

387
00:14:18,179 --> 00:14:19,480
OUT THERE A BIT MORE.

388
00:14:19,480 --> 00:14:20,581
PEOPLE HAD BEEN VERY INTERESTED

389
00:14:20,581 --> 00:14:21,749
IN TRYING TO FIGURE OUT IF

390
00:14:21,749 --> 00:14:23,017
THAT'S WHAT'S GOING ON.

391
00:14:23,017 --> 00:14:29,924
THIS IS SOME UNPUBLISHED WORK BY

392
00:14:29,924 --> 00:14:31,692
[INDISCERNIBLE] IN SEATTLE, HE

393
00:14:31,692 --> 00:14:34,495
RUNS THE GONORRHEA LAB THERE AND

394
00:14:34,495 --> 00:14:37,298
WHAT HE HAS SHOWN IS THAT IN MEN

395
00:14:37,298 --> 00:14:40,301
WHO HAVE SEX WITH MEN AT LEAST

396
00:14:40,301 --> 00:14:42,336
BEING SEEN IN SEATTLE COUNTY

397
00:14:42,336 --> 00:14:45,806
CLINICS WHERE  DOXY-PEP HAS BEEN

398
00:14:45,806 --> 00:14:47,708
INTRODUCED, THERE HAS BEENA AN

399
00:14:47,708 --> 00:14:50,311
INCREASE IN HIGH LEVELS OF

400
00:14:50,311 --> 00:14:51,178
TETRAPSYCHE LYNN RESISTANCE AND

401
00:14:51,178 --> 00:14:53,214
INDEED THAT THIS RESISTANCE WAS

402
00:14:53,214 --> 00:14:56,116
HIGHER AMONG PEOPLE WHO WERE

403
00:14:56,116 --> 00:14:56,951
USING DOXY-PEP.

404
00:14:56,951 --> 00:14:58,986
THESE ARE NOT REALLY NATIONALLY

405
00:14:58,986 --> 00:15:00,654
VALIDATED YET, BUT I THINK THIS

406
00:15:00,654 --> 00:15:01,589
IS AN EARLY SIGNAL, THAT WE'RE

407
00:15:01,589 --> 00:15:03,557
JUST GOING TO HAVE TO BE VERY,

408
00:15:03,557 --> 00:15:06,060
VERY CAREFUL AS THIS ROLLS OUT.

409
00:15:06,060 --> 00:15:10,297
AND ALSO, WE NEED TO,A SUM THAT

410
00:15:10,297 --> 00:15:12,533
DOXY-PEP WILL NOT WORK FOR

411
00:15:12,533 --> 00:15:13,400
GONORRHEA AND THAT WILL CONTINUE

412
00:15:13,400 --> 00:15:15,035
TO BE A BIG PROBLEM WHICH IS WHY

413
00:15:15,035 --> 00:15:17,905
WE NEED TO CONTINUE THAT WORK ON

414
00:15:17,905 --> 00:15:19,807
NEW ANTIBIOTICS, JUST A COUPLE

415
00:15:19,807 --> 00:15:20,574
COMMENTS ABOUT THIS, IT'S

416
00:15:20,574 --> 00:15:22,009
SOMETHING YOU MAY HAVE HEARD

417
00:15:22,009 --> 00:15:26,280
ABOUT, THIS WAS A NEW IN CLASS

418
00:15:26,280 --> 00:15:30,584
GIVING--YOU RACE INHIBITOR THAT

419
00:15:30,584 --> 00:15:31,785
NIAID ESSENTIALLY BANK ROLLED

420
00:15:31,785 --> 00:15:35,122
THE FIRST DEVELOPMENT PHASES OF,

421
00:15:35,122 --> 00:15:36,824
SO PRECLINICAL WORK, PHASE 1,

422
00:15:36,824 --> 00:15:38,926
PHASE 2, AND MOVE TO PHASE 3

423
00:15:38,926 --> 00:15:40,294
TRIAL INTO U.S. AND

424
00:15:40,294 --> 00:15:41,662
INTERNATIONAL SITES IN

425
00:15:41,662 --> 00:15:42,863
PARTNERSHIP WITH GUARD P.

426
00:15:42,863 --> 00:15:44,231
SO A REALLY GREAT WAY TO GET A

427
00:15:44,231 --> 00:15:47,334
DRUG OUT THERE THAT REALLY HAS

428
00:15:47,334 --> 00:15:47,801
NO COMMERCIAL MARKET.

429
00:15:47,801 --> 00:15:50,104
YOU KNOW YOU ARE NOT GOING TO BE

430
00:15:50,104 --> 00:15:52,373
RETIRING OFF THE PORTFOLIO

431
00:15:52,373 --> 00:15:54,441
SHARES OF YOUR GONORRHEA DRUG,

432
00:15:54,441 --> 00:15:56,143
SO IT'S REALLY IMPORTANT TO FIND

433
00:15:56,143 --> 00:15:58,545
WAYS TO GET THESE DRUGS STUDIED

434
00:15:58,545 --> 00:15:59,880
AS IS THE CASE FOR MANY OF THE

435
00:15:59,880 --> 00:16:04,652
DRUGS WE NEED TO DEVELOP FOR

436
00:16:04,652 --> 00:16:05,219
NEGLECTED DISEASES.

437
00:16:05,219 --> 00:16:06,520
WHY ARE WE REALLY CONCERNED THAT

438
00:16:06,520 --> 00:16:09,523
WE FIND THESE DRUGS, WELL, AS I

439
00:16:09,523 --> 00:16:11,492
JUST MENTIONED LAST SEPTEMBER,

440
00:16:11,492 --> 00:16:14,128
SO LAST MONTH, IN FRANCE, THERE

441
00:16:14,128 --> 00:16:16,697
WERE 4 CASES OF EXTENSIVELY DRUG

442
00:16:16,697 --> 00:16:18,599
RESISTANT GONORRHEA, THIS IS THE

443
00:16:18,599 --> 00:16:20,434
FIRST TIME THAT FRANCE HAS

444
00:16:20,434 --> 00:16:25,072
REPORTED ISOLATES THAT WERE

445
00:16:25,072 --> 00:16:25,739
HIGHLY RESISTANT TO SWREGHT

446
00:16:25,739 --> 00:16:29,777
ROUGH ATOM MICEIN AND CLEARLY

447
00:16:29,777 --> 00:16:31,712
RESISTANT TO SIEVE LAXON, THESE

448
00:16:31,712 --> 00:16:32,680
WERE TREATED WITH ANTIBIOTICS

449
00:16:32,680 --> 00:16:34,615
AND DID OKAY, BUT THESE

450
00:16:34,615 --> 00:16:35,783
INDIVIDUALS ACTUALLY HAD NOT

451
00:16:35,783 --> 00:16:37,184
TRAVELED WHICH IS NOT TERRIBLY

452
00:16:37,184 --> 00:16:43,057
SURPRISING GIVEN SORT OF SEXUAL

453
00:16:43,057 --> 00:16:43,691
PARTNERSHIPS, SEXUAL COMMERCE,

454
00:16:43,691 --> 00:16:45,259
SO WE NEED TO HAVE THESE DRUGs

455
00:16:45,259 --> 00:16:47,594
AS A BACK UP ESPECIALLY BECAUSE

456
00:16:47,594 --> 00:16:49,396
WE WILL RELY ON DOXY-PEP.

457
00:16:49,396 --> 00:16:50,331
OF COURSE THE ULTIMATE SOLUTION,

458
00:16:50,331 --> 00:16:52,566
I THINK WILL BE TO HAVE A

459
00:16:52,566 --> 00:16:52,900
VACCINE.

460
00:16:52,900 --> 00:16:55,069
THE QUESTION IS, WHAT IS THAT

461
00:16:55,069 --> 00:16:58,872
VACCINE GOING TO LOOK LIKE IN

462
00:16:58,872 --> 00:17:01,175
GONZALEZRY ISA A VERY TRICKY

463
00:17:01,175 --> 00:17:03,711
PATHOGEN BECAUSE IT DOESN'T

464
00:17:03,711 --> 00:17:05,446
INDUCE -- PROTECTIVE HUMAN

465
00:17:05,446 --> 00:17:06,080
IMMUNITY.

466
00:17:06,080 --> 00:17:07,614
IT DOESN'T INDUCE A MUCOSAL

467
00:17:07,614 --> 00:17:10,784
IMMUNE RESPONSE TO, SOME EXTENT

468
00:17:10,784 --> 00:17:12,286
IT INUSE DUCES A SYSTEMIC

469
00:17:12,286 --> 00:17:17,358
RESPONSE BUT IT'S BEEN HARD TO

470
00:17:17,358 --> 00:17:18,258
CHARACTERIZE THIS,

471
00:17:18,258 --> 00:17:19,526
[INDISCERNIBLE] HAS HAD A HUMAN

472
00:17:19,526 --> 00:17:20,894
GONORRHEA MODEL FOR MANY YEARS

473
00:17:20,894 --> 00:17:23,397
AT THE UNIVERSITY OF NORTH

474
00:17:23,397 --> 00:17:24,131
CAROLINA, MARSHAL HOPS IS,

475
00:17:24,131 --> 00:17:25,532
WOOING ON THAT NOW AND THAT

476
00:17:25,532 --> 00:17:26,734
LEDITOUS A LOT OF INSIGHTS ABOUT

477
00:17:26,734 --> 00:17:31,905
WHAT HAPPENS WHEN YOU INFECT THE

478
00:17:31,905 --> 00:17:33,507
MALE URETHRA WITH THIS BUG BUT

479
00:17:33,507 --> 00:17:34,775
IT'S BEEN VERY HARD TO FIGURE

480
00:17:34,775 --> 00:17:37,644
OUT HOW YOU CAN DO THAT IN A WAY

481
00:17:37,644 --> 00:17:41,482
THAT ILLICITS LONG STANDING

482
00:17:41,482 --> 00:17:41,749
IMMUNITY.

483
00:17:41,749 --> 00:17:43,650
WHAT GOT US A LITTLE EXCITED

484
00:17:43,650 --> 00:17:45,486
ABOUT THE POSSIBILITIES HERE,

485
00:17:45,486 --> 00:17:50,991
WAS THE EMERGENCE OF THE GROUP B

486
00:17:50,991 --> 00:17:53,560
MENING COCKAL VACCINE THAT CAME

487
00:17:53,560 --> 00:17:55,062
OUT IN THE MIDEARLY 2010S, AND

488
00:17:55,062 --> 00:17:59,299
SOME OF YOU MAY KNOW WHO WORKED

489
00:17:59,299 --> 00:18:03,170
ON THIS WHEN HE WAS AT GSK, AND

490
00:18:03,170 --> 00:18:05,439
HE USE THE WHOLE CONCEPT OF

491
00:18:05,439 --> 00:18:09,877
RIVERS VACNOLOGY WHICH WE KNOW

492
00:18:09,877 --> 00:18:12,046
NOW ARE VERY INTENTLY USING TO

493
00:18:12,046 --> 00:18:13,180
INTERROGATE THE RESPONSE TO

494
00:18:13,180 --> 00:18:18,786
PATHOGENS TO LOOK AT WHAT WOULD

495
00:18:18,786 --> 00:18:20,187
CONFER PROTECTION TO GROUP B

496
00:18:20,187 --> 00:18:21,755
MENING CAUCUS AND MOW YOU COULD

497
00:18:21,755 --> 00:18:23,190
MAKE A VACCINE THAT WOULD DO

498
00:18:23,190 --> 00:18:24,358
THIS BECAUSE OF CORS WE DIDN'T

499
00:18:24,358 --> 00:18:27,361
HAVE 1, WE HAD ACY, ET CETERA,

500
00:18:27,361 --> 00:18:29,329
AND THIS VACCINE HAS PROVEN TO

501
00:18:29,329 --> 00:18:32,066
BE EFFECTIVE IN AT LEAST IN THE

502
00:18:32,066 --> 00:18:32,699
MENING COCKAL WORLD.

503
00:18:32,699 --> 00:18:36,603
IT TURNS OUT THAT THE MAIN

504
00:18:36,603 --> 00:18:39,540
CONCOMPONENTS OF THIS VACCINE

505
00:18:39,540 --> 00:18:45,646
HAVE PROFOUND SEQUENCE

506
00:18:45,646 --> 00:18:47,014
SIMILARITY TO GONOCOCCALL

507
00:18:47,014 --> 00:18:48,348
MONOLOGUES, AND IF YOU DO THESE

508
00:18:48,348 --> 00:18:50,084
SPRMS CAN YOU MODEL AN IMMUNE

509
00:18:50,084 --> 00:18:52,086
RESPONSE IN PEOPLE AGAINST

510
00:18:52,086 --> 00:18:52,352
GONORRHEA.

511
00:18:52,352 --> 00:18:54,188
THIS WAS FIRST SIGNAL INDEED

512
00:18:54,188 --> 00:18:56,723
EPIDEMIOLOGIC STUDIES WHERE

513
00:18:56,723 --> 00:18:58,325
PEOPLE LOOKED BACK AT

514
00:18:58,325 --> 00:19:03,330
POPULATIONS THAT HAD GOTTEN

515
00:19:03,330 --> 00:19:06,066
TREATED WITH PROTECTIVE MENING

516
00:19:06,066 --> 00:19:08,135
COCCALL VACCINE AND SHOWED THAT

517
00:19:08,135 --> 00:19:14,108
SUBSEQUENTLY THEY HAD  LOWER

518
00:19:14,108 --> 00:19:15,976
LIKELIHOOD OF GONORRHEA.

519
00:19:15,976 --> 00:19:17,678
SO WE'RE JUST POINTING OUT THIS

520
00:19:17,678 --> 00:19:19,346
STUDY THAT'S BEING DONE BY DMID,

521
00:19:19,346 --> 00:19:20,681
TO BE CLEAR I WAS INVOLVED WITH

522
00:19:20,681 --> 00:19:22,182
THE STUDY BEFORE I CAME TO NIH,

523
00:19:22,182 --> 00:19:24,485
THIS IS A TODAY THAT IS GOING TO

524
00:19:24,485 --> 00:19:26,887
BE LOOKINGA THE EFFICACY OF THIS

525
00:19:26,887 --> 00:19:28,489
VACCINE FOR PREVENTION OF

526
00:19:28,489 --> 00:19:30,624
GONORRHEA, AND THE ENROLLMENT

527
00:19:30,624 --> 00:19:32,593
NOW STANDS AT OVER 23,000

528
00:19:32,593 --> 00:19:34,128
PARTICIPANTS AND VERY HOPEFUL

529
00:19:34,128 --> 00:19:36,630
THAT WE WILL SEE A SIGNAL HERE.

530
00:19:36,630 --> 00:19:39,833
THE POINT OF THE EDITORIAL THAT

531
00:19:39,833 --> 00:19:42,202
MIKE COHEN AND I WROTE WAS THAT

532
00:19:42,202 --> 00:19:43,937
WE PROBABLY DON'T NEED A PERFECT

533
00:19:43,937 --> 00:19:47,207
VACCINE TO HELP US OUT HERE.

534
00:19:47,207 --> 00:19:50,511
IF YOU MODEL THE EFFICACY OF A

535
00:19:50,511 --> 00:19:53,147
VACCINE AND IT'S EFFECT ON

536
00:19:53,147 --> 00:19:54,314
SPREAD OF GONORRHEA, YOU

537
00:19:54,314 --> 00:19:58,552
PROBABLY ONLY NEED SOMETHING IN

538
00:19:58,552 --> 00:20:02,456
THE RAINCHL OF 30-50% IF YOU CAN

539
00:20:02,456 --> 00:20:04,358
WIELD IT IN PEOPLE WHO ARE THE

540
00:20:04,358 --> 00:20:05,859
MOST EFFICIENT TRANSMITTERS AND

541
00:20:05,859 --> 00:20:08,128
THAT'S THE MOST INTERESTING

542
00:20:08,128 --> 00:20:11,932
THING ABOUT STD VACCINES, IT'S

543
00:20:11,932 --> 00:20:14,468
NOT A TYPICAL VACCINE, NOT A

544
00:20:14,468 --> 00:20:15,169
TYPICAL ADULT VACCINE, YOU HAVE

545
00:20:15,169 --> 00:20:16,837
TO THINK ABOUT WHO YOU ARE

546
00:20:16,837 --> 00:20:19,773
TRYING TO ATTRACT AND WHO'S

547
00:20:19,773 --> 00:20:23,477
LIKELY TO TRANSMIT AND THAT

548
00:20:23,477 --> 00:20:24,478
REQUIRES SOPHISTICATED MODELING.

549
00:20:24,478 --> 00:20:25,445
SO IT BRINGS TOGETHER A LOT OF

550
00:20:25,445 --> 00:20:25,746
PEOPLE.

551
00:20:25,746 --> 00:20:29,283
SO THE NICE CONCLUSION OF THIS,

552
00:20:29,283 --> 00:20:30,017
THE EDITORICAL WHICH COMMENTED

553
00:20:30,017 --> 00:20:31,418
ON THE PAPER THAT LOOKEDDA THE

554
00:20:31,418 --> 00:20:33,187
THIS MODEL WAS AGAIN, EVEN IF WE

555
00:20:33,187 --> 00:20:34,988
HAD SOMETHING WITH EFFICACY, WE

556
00:20:34,988 --> 00:20:36,223
COULD BUY SOMETIME AND AT THIS

557
00:20:36,223 --> 00:20:37,958
POINT, I THINK WHAT WE REALLY

558
00:20:37,958 --> 00:20:41,361
WANT TO DO IS BUY SOME TIME

559
00:20:41,361 --> 00:20:43,397
UNTIL WE GET MORE APPROPRIATE

560
00:20:43,397 --> 00:20:44,965
CANDIDATES FOR VACCINE.

561
00:20:44,965 --> 00:20:46,333
AND JUST TRANSITIONING TO

562
00:20:46,333 --> 00:20:49,403
DOXY-PEP, THAT'S HOW I SEE

563
00:20:49,403 --> 00:20:49,736
DOXY-PEP PEP.

564
00:20:49,736 --> 00:20:52,105
I SEE DOXY-PEP AS A BUYER OF

565
00:20:52,105 --> 00:20:54,908
TIME UNTIL WE CAN GET -- WE CAN

566
00:20:54,908 --> 00:20:56,210
GET A GOOD VACCINE FOR SOME MUCH

567
00:20:56,210 --> 00:21:01,582
THESE THINGS THAT REALLY AFFECT

568
00:21:01,582 --> 00:21:01,949
OUR COMMUNITIES.

569
00:21:01,949 --> 00:21:03,250
COMMENT ABOUT WOMEN BECAUSE I'M

570
00:21:03,250 --> 00:21:05,052
GOING TO TALK ABOUT DOXY-PEP

571
00:21:05,052 --> 00:21:08,088
LARGELY IN THE CONTEXT OF  MEN

572
00:21:08,088 --> 00:21:18,599
AND I WILL REMIND YOU THAT THE

573
00:21:21,435 --> 00:21:31,345
CDC, IN -- FOR THOSE WHO DON'T

574
00:21:31,345 --> 00:21:32,779
KNOW, IT'S STUDY SAYS OF MEN WHO

575
00:21:32,779 --> 00:21:34,281
HAVE SEX WITH MEN AND STUDIES

576
00:21:34,281 --> 00:21:36,250
SHOW THAT WILL REDUCE THE

577
00:21:36,250 --> 00:21:40,621
INCIDENCE OF GONORRHEA, SORRY

578
00:21:40,621 --> 00:21:41,622
CHLAMYDIA AND GONORRHEA BY

579
00:21:41,622 --> 00:21:42,789
SEIVET%, SO PEOPLE WERE EXCITED

580
00:21:42,789 --> 00:21:44,658
TO LOOK AT THIS IN WOMEN.

581
00:21:44,658 --> 00:21:47,427
WOMEN HAVE A HIGH INCIDENCE OF

582
00:21:47,427 --> 00:21:48,862
CURABLE STIs, THESE ARE DATA

583
00:21:48,862 --> 00:21:52,899
AGAIN FROM THE W. H. O. REPORT

584
00:21:52,899 --> 00:21:53,200
IN 2024.

585
00:21:53,200 --> 00:21:55,602
THERE WAS A FAIR AMOUNT OF

586
00:21:55,602 --> 00:21:58,505
EXCITEMENT THAT THIS MAY BE A

587
00:21:58,505 --> 00:22:00,574
POPULATION THAT COULD BENEFIT

588
00:22:00,574 --> 00:22:00,941
FROM DOXY-PEP.

589
00:22:00,941 --> 00:22:02,709
UNFORTUNATELY, THERE WAS A STUDY

590
00:22:02,709 --> 00:22:05,178
IN THE NEW ENGLAND JOURNAL THAT

591
00:22:05,178 --> 00:22:06,346
I WROTE ABOUT IT LAST DECEMBER

592
00:22:06,346 --> 00:22:08,015
SHOWING THAT IN A RANDOMIZED

593
00:22:08,015 --> 00:22:13,654
CONTROL TRIAL OF WOMEN IN KENYA,

594
00:22:13,654 --> 00:22:14,821
DOXY-PEP RELATIVE TO PLACEBO

595
00:22:14,821 --> 00:22:16,223
GIVEN IN THAT DOSAGE I MENTIONED

596
00:22:16,223 --> 00:22:18,792
HAD NO EFFECT ON THE INCIDENCE

597
00:22:18,792 --> 00:22:21,862
OF CHLAMYDIA, SYPHILIS OR

598
00:22:21,862 --> 00:22:22,129
GONORRHEA.

599
00:22:22,129 --> 00:22:27,134
I FOUND THAT TRIAL TO BE -- I

600
00:22:27,134 --> 00:22:29,736
DON'T WANT TO BE TOO, TOO

601
00:22:29,736 --> 00:22:34,274
NEGATIVE BUT I FOUND THE TRIAL

602
00:22:34,274 --> 00:22:36,510
TO BE INSUFFICIENTLY THOUGHTFUL

603
00:22:36,510 --> 00:22:39,146
ABOUT ITS DESIGN, I WOULD SAY.

604
00:22:39,146 --> 00:22:41,148
NO SOT MUCH ITS EXECUTION, IT'S

605
00:22:41,148 --> 00:22:43,784
WELL DONE, BUT WHAT THE TRIAL

606
00:22:43,784 --> 00:22:45,319
DID ESSENTIALLY WAS TO TAKE AN

607
00:22:45,319 --> 00:22:48,455
INTERVENTION THAT WAS

608
00:22:48,455 --> 00:22:49,756
ESSENTIALLY DESIGNED TO PREVENT

609
00:22:49,756 --> 00:22:53,794
STIs IN A POPULATION WHO HAD

610
00:22:53,794 --> 00:22:55,662
VERY FREQUENT SEX AND REALLY

611
00:22:55,662 --> 00:22:58,465
WANTED TO HAVE SAFE SEX IN THE

612
00:22:58,465 --> 00:23:01,401
CONTEXT OF HIV PREEXPOSURE

613
00:23:01,401 --> 00:23:03,203
PROPHYLAXIS, I. E. WITHOUT

614
00:23:03,203 --> 00:23:05,072
CONDOMS AND NOT GET STIs, AND

615
00:23:05,072 --> 00:23:07,307
THEN TRANSFER THAT TO A

616
00:23:07,307 --> 00:23:10,010
POPULATION OF WOMEN IF KENYA,

617
00:23:10,010 --> 00:23:11,778
CISGENDER WOMEN AND USE THE SAME

618
00:23:11,778 --> 00:23:13,213
PRODUCT FOR ESSENTIALLY WHAT WAS

619
00:23:13,213 --> 00:23:14,614
ASSUMED TO BE THE SAME BENEFIT.

620
00:23:14,614 --> 00:23:16,016
SO I'LL LET YOU THINK ABOUT THAT

621
00:23:16,016 --> 00:23:18,018
A LITTLE BIT.

622
00:23:18,018 --> 00:23:19,953
I THINK THAT WHEN THINK ABOUT

623
00:23:19,953 --> 00:23:21,588
DOXY-PEP, REALLY AGAIN, IT WAS

624
00:23:21,588 --> 00:23:25,559
THOUGHT ABOUT IN THE CONTEXT OF

625
00:23:25,559 --> 00:23:28,695
HIV PEP WORKS SO WELL,

626
00:23:28,695 --> 00:23:31,264
PREEXPOSURE PROPHYLAXIS AND OF

627
00:23:31,264 --> 00:23:32,733
COURSE IT'S   PERRY EXPOSURE

628
00:23:32,733 --> 00:23:35,035
PROPHYLAXIS YET WE WERE SEEING

629
00:23:35,035 --> 00:23:37,604
SUCH INCREDIBLY HIGH RATES OF

630
00:23:37,604 --> 00:23:39,373
STIs, WHAT WERE WE GOING TO DO

631
00:23:39,373 --> 00:23:40,273
ABOUT THAT, RIGHT?

632
00:23:40,273 --> 00:23:42,576
SO WE FIGURED OUT HOW TO REDUCE

633
00:23:42,576 --> 00:23:43,977
HIV INFECTIONS IN MEN WHO HAVE

634
00:23:43,977 --> 00:23:45,479
SEX WITH MEN, AND NOW, WHAT ARE

635
00:23:45,479 --> 00:23:47,214
WE GOING TO DO ABOUT THE VERY,

636
00:23:47,214 --> 00:23:49,716
VERY HIGH RATES OF STIs THAT

637
00:23:49,716 --> 00:23:50,484
WE'RE SEEING.

638
00:23:50,484 --> 00:23:53,787
SO THAT WAS WHERE DOXY-PEP CAME

639
00:23:53,787 --> 00:23:53,987
IN.

640
00:23:53,987 --> 00:23:56,156
SO WHAT I ARGUED IN THIS

641
00:23:56,156 --> 00:23:57,758
EDITORIAL WAS THAT IT'S REALLY

642
00:23:57,758 --> 00:23:59,092
TIME TO STOP THINKING ABOUT

643
00:23:59,092 --> 00:24:01,995
WOMEN AS KIND OF A ME TOO

644
00:24:01,995 --> 00:24:03,497
POPULATION AND THAT'S EXACTLY

645
00:24:03,497 --> 00:24:07,401
WHAT I THINK THAT STUDY DID.

646
00:24:07,401 --> 00:24:08,935
THEY REALLY DIDN'T ACCOUNT FOR

647
00:24:08,935 --> 00:24:11,938
WHY WOMEN MIGHT WANT TO PREVENT

648
00:24:11,938 --> 00:24:13,573
STIs, DID WOMEN KNOW WHAT

649
00:24:13,573 --> 00:24:15,776
STIs THEY WERE GETTING.

650
00:24:15,776 --> 00:24:17,544
NINETY% OF THE CHLAMYDIA IN

651
00:24:17,544 --> 00:24:18,178
WOMEN IS ASYMPTOMATIC, SO WHEN

652
00:24:18,178 --> 00:24:20,514
YOU LOOK AT KNOWLEDGE OF

653
00:24:20,514 --> 00:24:21,915
CHLAMYDIA AND KNOWLEDGE OF THE

654
00:24:21,915 --> 00:24:22,883
CONSEQUENCES PARTICULARLY IN

655
00:24:22,883 --> 00:24:25,385
NEEZ POPULATIONS, IT CAN BE

656
00:24:25,385 --> 00:24:25,986
VERY, VERY LOW.

657
00:24:25,986 --> 00:24:30,924
SO LOTS OF THINGS THAT THINK

658
00:24:30,924 --> 00:24:31,591
ABOUT.

659
00:24:31,591 --> 00:24:34,327
THAT SAID, DESPITE ALL MY

660
00:24:34,327 --> 00:24:39,366
SKEPTICISM, DESPITE ALL MY NOT

661
00:24:39,366 --> 00:24:40,734
NECESSARILY NEGATIVITY, BUT

662
00:24:40,734 --> 00:24:43,403
CAUTIOUS, I THINK IT'S PRETTY

663
00:24:43,403 --> 00:24:44,905
CLEAR THAT DOXY-PEP IS HAVING AN

664
00:24:44,905 --> 00:24:45,338
EFFECT.

665
00:24:45,338 --> 00:24:48,475
THESE ARE DATA THAT WERE SHOWN

666
00:24:48,475 --> 00:24:51,144
AT [INDISCERNIBLE] LAST YEAR AND

667
00:24:51,144 --> 00:24:52,646
OUR -- ABOUT TO COME OUT VERY

668
00:24:52,646 --> 00:24:55,182
SOON IN A MAJOR JOURNAL AGAIN

669
00:24:55,182 --> 00:24:59,019
WITH AN EDITORIAL THAT YOU MIGHT

670
00:24:59,019 --> 00:24:59,619
FIND OF INTEREST.

671
00:24:59,619 --> 00:25:03,089
AND WHAT THIS IS SHOWING IS THAT

672
00:25:03,089 --> 00:25:06,827
IN SAN FRANCISCO WHICH EMBRACED

673
00:25:06,827 --> 00:25:07,527
DOXY-PEP GUIDELINES VERY EARLY

674
00:25:07,527 --> 00:25:11,398
MUCH TO THE  DISMAY I WOULD SAY

675
00:25:11,398 --> 00:25:12,666
OF OTHER COUNTIES INCLUDING

676
00:25:12,666 --> 00:25:13,733
SEALT WHICH DID NOT GO THIS

677
00:25:13,733 --> 00:25:14,768
ROUTE BECAUSE THEY WERE

678
00:25:14,768 --> 00:25:17,504
CONCERNED ABOUT A LACK OF

679
00:25:17,504 --> 00:25:18,572
EVIDENCE AND ALSO INCREASING

680
00:25:18,572 --> 00:25:21,374
TETRAPSYCHE LINE RESISTANCE IN

681
00:25:21,374 --> 00:25:25,579
GONORRHEA, WHAT THE INVESTIGATOR

682
00:25:25,579 --> 00:25:27,113
SHOWED AT CROI THIS YEAR WAS

683
00:25:27,113 --> 00:25:31,151
THAT OVER THE COURSE OF ABOUT A

684
00:25:31,151 --> 00:25:32,319
YEAR OF MAKING DOXY-PEP

685
00:25:32,319 --> 00:25:34,788
AVAILABLE IN THE SAN FRANCISCO

686
00:25:34,788 --> 00:25:37,023
STD CLINICS THAT THERE WAS A 51%

687
00:25:37,023 --> 00:25:40,193
DECREASE IN EARLY SYPHILIS, A

688
00:25:40,193 --> 00:25:42,829
50% DECREASE IN CHLAMYDIA AND

689
00:25:42,829 --> 00:25:43,697
SURPRISE, NO DECREASE IN

690
00:25:43,697 --> 00:25:44,064
GONORRHEA.

691
00:25:44,064 --> 00:25:46,466
SO THIS IS REALLY THE FIRST REAL

692
00:25:46,466 --> 00:25:50,637
WORLD EVIDENT THAT WE HAVE IN A

693
00:25:50,637 --> 00:25:52,205
COMMUNITY BASED SETTING AND IT'S

694
00:25:52,205 --> 00:25:54,374
REALLY A TESTAMENT TO I THINK

695
00:25:54,374 --> 00:25:57,544
THE ROBUST NATURE OF PUBLIC

696
00:25:57,544 --> 00:25:58,845
HEALTH PROGRAM IN SAN FRANCISCO,

697
00:25:58,845 --> 00:26:02,916
TO SHOW THAT YOU CAN ACTUALLY

698
00:26:02,916 --> 00:26:04,951
IMPACT POPULATION BASED

699
00:26:04,951 --> 00:26:07,087
INCIDENCE OF DISEASE.

700
00:26:07,087 --> 00:26:07,854
INTERESTINGLY ENOUGH, THE

701
00:26:07,854 --> 00:26:10,357
MAGNITUDE OF THE DECLINES IN

702
00:26:10,357 --> 00:26:12,392
BOTH OF THESE INFECTIONS IS VERY

703
00:26:12,392 --> 00:26:14,361
SIMILAR TO WHAT WAS SHOWN IN THE

704
00:26:14,361 --> 00:26:14,961
RANDOMIZED CONTROL TRIALS IN

705
00:26:14,961 --> 00:26:17,998
FRANCE AND IN THE U.S. WHICH WAS

706
00:26:17,998 --> 00:26:18,331
AROUND 50-70%.

707
00:26:18,331 --> 00:26:22,168
SO I THINK THIS WAS VERY

708
00:26:22,168 --> 00:26:22,903
ENCOURAGING.

709
00:26:22,903 --> 00:26:25,405
I THINK THE QUESTION IS REALLY

710
00:26:25,405 --> 00:26:27,874
GOING TO BE WHAT ARE WE GOING TO

711
00:26:27,874 --> 00:26:28,408
DO FOR WOMEN?

712
00:26:28,408 --> 00:26:31,111
IS IT GOING TO WORK FOR WOMEN?

713
00:26:31,111 --> 00:26:32,846
WOMEN ONCE AGAIN ARE COMPLETELY

714
00:26:32,846 --> 00:26:34,814
LEFT OUT OF THE GUIDELINES, I

715
00:26:34,814 --> 00:26:36,550
THINK THERE'S AN APPETITE TO

716
00:26:36,550 --> 00:26:38,184
STUDY IN WOMEN, RIGHT NOW

717
00:26:38,184 --> 00:26:39,586
PROVIDERS ARE REALLY LEFT WITH

718
00:26:39,586 --> 00:26:42,522
THIS SORT OF JUST TALK TO YOUR

719
00:26:42,522 --> 00:26:45,492
PATIENT AND FIGURE OUT IF IT IS

720
00:26:45,492 --> 00:26:46,793
FOR THEM.

721
00:26:46,793 --> 00:26:50,497
BUT AGAIN, NO CLEAR GUIDANCE FOR

722
00:26:50,497 --> 00:26:51,264
CISGENDER WOMEN, TRANSGENDER

723
00:26:51,264 --> 00:26:52,799
WOMEN WERE INCLUDED IN THIS

724
00:26:52,799 --> 00:26:55,335
GROUP AND ACTUALLY DID QUITE

725
00:26:55,335 --> 00:26:56,536
WELL.

726
00:26:56,536 --> 00:26:59,372
SO OVERALL I WOULD SAY EXCITING

727
00:26:59,372 --> 00:26:59,839
AND INTERESTING TIMES.

728
00:26:59,839 --> 00:27:01,908
THERE ARE GOING TO BE A LOT OF

729
00:27:01,908 --> 00:27:02,576
QUESTIONS, I THINK ABOUT HOW

730
00:27:02,576 --> 00:27:06,413
THIS IS GOING TO ROLL OUT IN

731
00:27:06,413 --> 00:27:07,514
POPULATIONS WHO MIGHT NOT BE

732
00:27:07,514 --> 00:27:09,015
USING IT AS FREQUENTLY.

733
00:27:09,015 --> 00:27:11,151
I SHOULD MENTION THAT IN THE

734
00:27:11,151 --> 00:27:12,452
RANDOMIZED CONTROL TRIALS OF

735
00:27:12,452 --> 00:27:15,155
DOXY-PEP, THERE WERE NO DATA FOR

736
00:27:15,155 --> 00:27:17,223
THIS GROUP BUT ON AVERAGE THE

737
00:27:17,223 --> 00:27:19,292
PARTICIPANTS WHO WERE USING IT,

738
00:27:19,292 --> 00:27:21,161
WERE USING IT 4 TIMES A WEEK.

739
00:27:21,161 --> 00:27:24,798
SO, 4 TIMES A WEEK OF POST

740
00:27:24,798 --> 00:27:26,900
EXPOSURE PROPHYLAXIS IS A LOT.

741
00:27:26,900 --> 00:27:28,635
AND IT'S PRETTY MUCH EQUIVALENT

742
00:27:28,635 --> 00:27:31,671
TO THE MINIMUM DOSE THAT YOU

743
00:27:31,671 --> 00:27:34,174
PROBABLY NEED TO GET SORT OF

744
00:27:34,174 --> 00:27:34,874
PREEXPOSURE TO PROPHYLAXIS FOR

745
00:27:34,874 --> 00:27:39,946
IF YOU THINK ABOUT IT FOR

746
00:27:39,946 --> 00:27:41,214
TENOFOFAVIR, IT WILL MAKE SENSE

747
00:27:41,214 --> 00:27:42,682
SO WILL THAT TRANSLATE TO PEOPLE

748
00:27:42,682 --> 00:27:45,919
WHO ARE WILL NOT BE AS SEXUALLY

749
00:27:45,919 --> 00:27:48,088
ACTIVE OR FREQUENTLY SEXUALLY

750
00:27:48,088 --> 00:27:48,355
ACTIVE.

751
00:27:48,355 --> 00:27:48,788
WE DON'T KNOW.

752
00:27:48,788 --> 00:27:51,358
SHOULD WE LOOK AT A PREAND POST

753
00:27:51,358 --> 00:27:52,325
DOSE FOR PEOPLE WHO MIGHT WANT

754
00:27:52,325 --> 00:27:54,160
TO BE COVERED FOR A WEEKEND AND

755
00:27:54,160 --> 00:27:54,494
WEEK.

756
00:27:54,494 --> 00:27:56,396
I THINK THOSE ARE INTERESTING

757
00:27:56,396 --> 00:27:57,797
QUESTIONS THAT THE

758
00:27:57,797 --> 00:27:59,366
PHARMACOKINETICS AND ADDRESS AND

759
00:27:59,366 --> 00:28:02,969
REAL WORLD STUDIES CAN ADDRESS.

760
00:28:02,969 --> 00:28:06,239
AGAIN, I JUST WANT TO POINT OUT

761
00:28:06,239 --> 00:28:10,610
THAT WE ARE PROBABLY UP AGAINST

762
00:28:10,610 --> 00:28:13,780
A BURGEONING INCREASE IN

763
00:28:13,780 --> 00:28:17,751
TETRAPSYCHE LINE RESISTANCE THAT

764
00:28:17,751 --> 00:28:19,686
PREDATED THE DOXY-PEP TIMELINE

765
00:28:19,686 --> 00:28:20,654
SO THE GONORRHEA PROBLEM IS NOT

766
00:28:20,654 --> 00:28:26,192
GOING TO GO,A  AWAY AND I THINKI

767
00:28:26,192 --> 00:28:26,726
MADE THAT POINT.

768
00:28:26,726 --> 00:28:27,694
SO IF YOU LOOK AT WHAT'S

769
00:28:27,694 --> 00:28:30,130
HAPPENING IN THE U.S. RIGHT NOW,

770
00:28:30,130 --> 00:28:31,998
THERE'S SEVERAL UPTAKE OF

771
00:28:31,998 --> 00:28:32,832
ADOPTER CITIES, PHILADELPHIA,

772
00:28:32,832 --> 00:28:34,200
BALTIMORE, THEY HAVE BEEN USING

773
00:28:34,200 --> 00:28:35,702
IT QUITE FREQUENTLY AND

774
00:28:35,702 --> 00:28:36,469
OBVIOUSLY SAN FRANCISCO, AND I

775
00:28:36,469 --> 00:28:38,004
THINK WE CAN SAY RIGHT NOW,

776
00:28:38,004 --> 00:28:39,939
BASED ON THE RANDOMIZED CONTROL

777
00:28:39,939 --> 00:28:42,342
TRIAL DATA, AND THE POPULATION

778
00:28:42,342 --> 00:28:44,444
LEVEL DATA COMING OUT OF

779
00:28:44,444 --> 00:28:45,979
SAN FRANCISCO, THAT IT IS

780
00:28:45,979 --> 00:28:51,618
EFFECTIVE IN PREVENTING SYPHILIS

781
00:28:51,618 --> 00:28:53,019
AND CHLAMYDIA.

782
00:28:53,019 --> 00:28:54,754
ONE THING I WOULD MENTION IS

783
00:28:54,754 --> 00:28:57,157
THAT THERE AREN'T A LOT OF DATA

784
00:28:57,157 --> 00:29:01,961
ON WHETHER IT PREVENTS ANATOMIC

785
00:29:01,961 --> 00:29:04,264
SITE SPECIFIC INFECTION FOR

786
00:29:04,264 --> 00:29:05,565
CHLAMYDIA IN PARTICULAR, SO IS

787
00:29:05,565 --> 00:29:09,803
IT BETTER AT PREVENTING RECTAL

788
00:29:09,803 --> 00:29:11,304
VERSUS URETHRAL VERSUS

789
00:29:11,304 --> 00:29:12,272
PHARYNGIAL INFECTION, WE REALLY

790
00:29:12,272 --> 00:29:12,572
DON'T KNOW.

791
00:29:12,572 --> 00:29:15,275
SOME OF THOSE THINGS MAY BE

792
00:29:15,275 --> 00:29:15,608
IMPORTANT.

793
00:29:15,608 --> 00:29:17,277
I WOULD SAY THE BIGGEST NAY

794
00:29:17,277 --> 00:29:20,380
SAYERS ARE ASKING, SO, WHAT'S

795
00:29:20,380 --> 00:29:23,917
THE BIG DEAL, WHY WORK SO HARD

796
00:29:23,917 --> 00:29:24,784
TO PREVENT CHLAMYDIA INFECTION

797
00:29:24,784 --> 00:29:26,619
IN MEN WHO HAVE SEX WITH MEN.

798
00:29:26,619 --> 00:29:30,156
IT'S NOT REALLY CAUSING ANY

799
00:29:30,156 --> 00:29:30,557
PROBLEMS.

800
00:29:30,557 --> 00:29:32,792
SO PUT THAT OUT THERE AGAIN, I

801
00:29:32,792 --> 00:29:34,260
WOULD LOVE TO HEAR YOUR THOUGHTS

802
00:29:34,260 --> 00:29:35,228
ABOUT THAT BUT [INDISCERNIBLE]

803
00:29:35,228 --> 00:29:39,065
AND THE GROUP IN MELBOURNE,

804
00:29:39,065 --> 00:29:40,600
AUSTRALIA HAVE BEEN PRETTY

805
00:29:40,600 --> 00:29:41,601
PROVOCATIVE IN THIS REGARD.

806
00:29:41,601 --> 00:29:43,737
I THINK THERE'S A LOT OF DEBATE

807
00:29:43,737 --> 00:29:45,605
TO BE HAD ON OTHER SIDE, NOT THE

808
00:29:45,605 --> 00:29:48,108
LEAST OF WHICH TO DO IS WITH

809
00:29:48,108 --> 00:29:50,510
JUST SORT OF THE WHOLE CONCEPT

810
00:29:50,510 --> 00:29:52,011
OF SEXUAL HEALTH.

811
00:29:52,011 --> 00:29:55,115
HOW DO YOU HAVE SORT OF SEXUAL

812
00:29:55,115 --> 00:29:55,782
HEALTH WITH THE ASSURANCE THAT

813
00:29:55,782 --> 00:29:57,984
YOU'RE NOT GOING TO BE ABLE TO

814
00:29:57,984 --> 00:30:00,153
TRANSMIT OR ACQUIRE THESE

815
00:30:00,153 --> 00:30:01,988
INFECTIONS SO IT'S A VERY, VERY

816
00:30:01,988 --> 00:30:03,423
RICH AREA, I WOULD SAY OF

817
00:30:03,423 --> 00:30:08,061
DEPARTICIPATE  --

818
00:30:08,061 --> 00:30:08,561
DEBATE.

819
00:30:08,561 --> 00:30:10,163
I ALREADY MENTIONED THE DECLINE

820
00:30:10,163 --> 00:30:12,332
IN SYPHILIS AND TO DATE NO

821
00:30:12,332 --> 00:30:14,934
IMPACT ON GONORRHEA THAT WE

822
00:30:14,934 --> 00:30:17,704
REALLY CAN TELL AND THE CONCERN

823
00:30:17,704 --> 00:30:18,571
WITH RESISTANCE.

824
00:30:18,571 --> 00:30:20,039
THERE ARE A COUPLE OF OTHER

825
00:30:20,039 --> 00:30:22,642
CONCERNS, I WOULD JUST MENTION

826
00:30:22,642 --> 00:30:32,719
REMEMBER THAT WE USE DOX

827
00:30:32,719 --> 00:30:34,554
YCYCLINE, TO TREAT BAF, SO THERE

828
00:30:34,554 --> 00:30:37,490
ARE PEOPLE WHO ARE INTERESTED IN

829
00:30:37,490 --> 00:30:42,595
TRACKING COMMUNITY BASED STAFF

830
00:30:42,595 --> 00:30:43,062
AURIOUS ANTIMICROBIAL

831
00:30:43,062 --> 00:30:45,131
SUSCEPTIBILITY, THERE IS A

832
00:30:45,131 --> 00:30:47,600
SUGGESTION THAT THERE MAY BE A

833
00:30:47,600 --> 00:30:49,836
GROUP CASE FOR STREP, I THINK

834
00:30:49,836 --> 00:30:50,603
IT'S THEORETICAL AND I DON'T

835
00:30:50,603 --> 00:30:52,172
KNOW WHAT THE OUTCOME OF THAT

836
00:30:52,172 --> 00:30:55,608
REALLY IS, AND SO, I WOULD SAY,

837
00:30:55,608 --> 00:30:57,343
THAT IT'S JUST GOING TO BE

838
00:30:57,343 --> 00:31:00,180
REALLY IMPORTANT TO MONITOR THE

839
00:31:00,180 --> 00:31:00,747
IMPACT.

840
00:31:00,747 --> 00:31:02,982
I HAVE PERSONALLY, WHEN I WAS

841
00:31:02,982 --> 00:31:05,585
PRACTICE RESEARCH IT-SHERLOCKING

842
00:31:05,585 --> 00:31:08,054
IS SEEING PATIENTS BEEN PRETTY

843
00:31:08,054 --> 00:31:10,123
LIBERAL WITH THE DISPENSATION OF

844
00:31:10,123 --> 00:31:11,891
DOXY-PEPY PEP, IT WAS GOOD, BUT

845
00:31:11,891 --> 00:31:13,593
PEOPLE NEED TO UNDERSTAND THAT

846
00:31:13,593 --> 00:31:17,697
IT IS NOT GOING TO BE PANACEA

847
00:31:17,697 --> 00:31:18,298
FOR PREVENTING EVERYTHING AND

848
00:31:18,298 --> 00:31:20,266
YOU STILL GOT TO WORRY ABOUT

849
00:31:20,266 --> 00:31:22,435
GONORRHEA, PEOPLE ARE ALSO VERY

850
00:31:22,435 --> 00:31:24,170
INTERESTED IN FOLLOWING THE

851
00:31:24,170 --> 00:31:28,274
EFFECT ON THE GUT MICROBIOME. 

852
00:31:28,274 --> 00:31:36,583
YOU KNOW WE USE DOXYCYCLINE FOR

853
00:31:36,583 --> 00:31:38,151
MANY THINGS, FOR LIME

854
00:31:38,151 --> 00:31:39,352
PROPHYLAXIS AND ALL KINDS OF

855
00:31:39,352 --> 00:31:40,687
OTHER THINGS SO I DON'T THINK WE

856
00:31:40,687 --> 00:31:43,890
WILL SEE A BIG PROBLEM WITH THE

857
00:31:43,890 --> 00:31:44,824
GI MICROBIOME, BUT I REALLY

858
00:31:44,824 --> 00:31:45,992
DON'T THINK WE KNOW AND I THINK

859
00:31:45,992 --> 00:31:47,894
WE WILL HAVE TO LOOK CAREFULLY

860
00:31:47,894 --> 00:31:48,962
AT IT.

861
00:31:48,962 --> 00:31:51,030
SO THAT IS MY SUMMARY OF WHERE

862
00:31:51,030 --> 00:31:53,199
WE'RE AT IN DOXY-PEP.

863
00:31:53,199 --> 00:31:56,202
INTERESTED IN HEARING ANY

864
00:31:56,202 --> 00:31:57,237
COMMENTS OR QUESTIONS BEFORE I

865
00:31:57,237 --> 00:31:57,704
SHIFT TO HIV.

866
00:31:57,704 --> 00:31:59,405
I THINK THERE'S NOTHING COMING

867
00:31:59,405 --> 00:32:00,506
UP FOR WOMEN ANYTIME SOON,

868
00:32:00,506 --> 00:32:01,708
IMEAN, IF YOU ARE TAKING CARE OF

869
00:32:01,708 --> 00:32:04,811
WOMEN WHO ARE INTERESTED IN

870
00:32:04,811 --> 00:32:06,713
THIS, I THINK THIS HAS TO BE A

871
00:32:06,713 --> 00:32:07,513
ONE-ON-ONE CONVERSATION AND I

872
00:32:07,513 --> 00:32:10,483
THINK WE HAVE TO SAY WE DON'T

873
00:32:10,483 --> 00:32:11,618
KNOW THE PHARMACOKINETICS, IT

874
00:32:11,618 --> 00:32:13,353
SUGGESTS THEY'RE GOOD AS

875
00:32:13,353 --> 00:32:16,022
RECOMMENDED BUT THAT'S WHERE

876
00:32:16,022 --> 00:32:16,456
WE'RE AT.

877
00:32:16,456 --> 00:32:18,358
ALL RIGHT.

878
00:32:18,358 --> 00:32:18,892
I'M GOING ON.

879
00:32:18,892 --> 00:32:20,960
WE WILL SAVE QUESTIONS FOR THE

880
00:32:20,960 --> 00:32:21,561
END.

881
00:32:21,561 --> 00:32:23,596
SO LET'S TALK A LITTLE BIT

882
00:32:23,596 --> 00:32:24,931
ABOUT, I THINK THE -- I DON'T

883
00:32:24,931 --> 00:32:26,733
KNOW IF I WANT TO SAY IT'S MORE

884
00:32:26,733 --> 00:32:32,138
EXCITING BUT IT'S CERTAINLY MORE

885
00:32:32,138 --> 00:32:34,040
QUICK MOVING AS THE FIELD OF HIV

886
00:32:34,040 --> 00:32:35,708
ALWAYS IS, RELATIVE TO STIs,

887
00:32:35,708 --> 00:32:38,077
AND I DON'T NEED TO BELABOR SOME

888
00:32:38,077 --> 00:32:39,646
OF THESE STATISTICS WITH YOU.

889
00:32:39,646 --> 00:32:43,549
YOU KNOW I THINK THAT THE HIV

890
00:32:43,549 --> 00:32:46,686
PANDEMIC IS NOT SLOWING DOWN AND

891
00:32:46,686 --> 00:32:49,689
IT CONTINUES TO AFFECT GROWING

892
00:32:49,689 --> 00:32:51,257
EPIDEMICS OUTSIDE OF SUB-SAHARAN

893
00:32:51,257 --> 00:32:54,327
AFRICA, IN FACT, AT MIEWN ITCH

894
00:32:54,327 --> 00:32:54,894
INTERNATIONAL AIDS SOCIETY

895
00:32:54,894 --> 00:32:55,662
MEETING THIS YEAR, IT WAS

896
00:32:55,662 --> 00:32:57,664
REPORTED THAT FOR THE FIRST

897
00:32:57,664 --> 00:33:00,233
TIME, THE INCIDENCE OUTSIDE OF

898
00:33:00,233 --> 00:33:01,834
SUB-SAHARAN AFRICA IN SEVERAL

899
00:33:01,834 --> 00:33:03,770
COUNTRIES EXCEEDED THAT OF

900
00:33:03,770 --> 00:33:04,504
SUB-SAHARAN AFRICA WHICH SHOWS

901
00:33:04,504 --> 00:33:06,606
THAT WHEN YOU PUT RESOURCES TO

902
00:33:06,606 --> 00:33:09,375
SOMETHING, LIKE WE HAVE FOR HIV

903
00:33:09,375 --> 00:33:10,543
PREVENTION AND SUB-SAHARAN

904
00:33:10,543 --> 00:33:11,844
AFRICA, IT MIGHT TAKE SOME TIME

905
00:33:11,844 --> 00:33:15,048
BUT YOU WILL HAVE AN IMPACT AND

906
00:33:15,048 --> 00:33:16,683
WE CLEARLY HAVE HAD IN THOSE

907
00:33:16,683 --> 00:33:16,983
COUNTRIES.

908
00:33:16,983 --> 00:33:18,451
ON TOP OF THIS, THE RESOURCES

909
00:33:18,451 --> 00:33:20,520
FOR HIV, AS I THINK THOSE OF YOU

910
00:33:20,520 --> 00:33:22,956
NATHE FIELD KNOW HAVE DROPPED,

911
00:33:22,956 --> 00:33:23,323
RIGHT?

912
00:33:23,323 --> 00:33:24,991
WE'RE NOT GETTING MORE

913
00:33:24,991 --> 00:33:28,328
INVESTMENT IN HIV PREVENTION AND

914
00:33:28,328 --> 00:33:29,362
IN HIV TREATMENT.

915
00:33:29,362 --> 00:33:30,997
IF ANYTHING WE'RE BEING

916
00:33:30,997 --> 00:33:32,165
QUESTIONED MORE ABOUT WHAT THOSE

917
00:33:32,165 --> 00:33:34,000
DOLLARS ARE BEING USED FOR AND

918
00:33:34,000 --> 00:33:35,234
WHY WE NEED THEM.

919
00:33:35,234 --> 00:33:38,104
AND THEN OF COURSE, JUST A

920
00:33:38,104 --> 00:33:40,373
REMINDER THAT WHEN YOU LOOK AT

921
00:33:40,373 --> 00:33:44,677
WHO IS MORE LIKELY TO GET

922
00:33:44,677 --> 00:33:45,845
INFECTED WITH HIV, PARTICULARLY

923
00:33:45,845 --> 00:33:48,681
IN EASTERN AND SOUTHERN AFRICA,

924
00:33:48,681 --> 00:33:52,885
ADOLESCENT GIRLS ARE REALLY THE

925
00:33:52,885 --> 00:33:55,388
MAIN FOCUS FOR MANY, MANY

926
00:33:55,388 --> 00:33:56,022
INTERVENTIONS.

927
00:33:56,022 --> 00:33:58,691
SIX TIMES AS LIKELY TO ACQUIRE

928
00:33:58,691 --> 00:34:00,560
HIV, BOYS SENT TO GET IT LATER,

929
00:34:00,560 --> 00:34:03,896
LATER IN LIFE, GIRLS TEND TO GET

930
00:34:03,896 --> 00:34:05,365
IT EARLIER AND OFTEN SIN DEMIC

931
00:34:05,365 --> 00:34:08,267
WITH RATES OF EARLY PREGNANCY

932
00:34:08,267 --> 00:34:09,202
AND UNINTENDED PREGNANCY AND

933
00:34:09,202 --> 00:34:10,103
GENDER BASED I HAVEERENCE.

934
00:34:10,103 --> 00:34:15,575
SO I 

935
00:34:15,575 --> 00:34:16,743
-- GENDER BASED VIOLENCE.

936
00:34:16,743 --> 00:34:22,181
SO I WILL TAKE A QUICK DETOUR TO

937
00:34:22,181 --> 00:34:24,083
TALK ABOUT PREVENTION, BUT TO

938
00:34:24,083 --> 00:34:25,251
THINK ABOUT WHOLISTICALLY WITH

939
00:34:25,251 --> 00:34:26,953
WE THINK ABOUT PREVENTING

940
00:34:26,953 --> 00:34:27,720
INFECTIONS, IT'S IMPORTANT TO

941
00:34:27,720 --> 00:34:29,355
THINK ABOUT NOT JUST THE MAGIC

942
00:34:29,355 --> 00:34:30,757
PILLS AND SHOTS BUT WE HAVE TO

943
00:34:30,757 --> 00:34:32,392
THINK ABOUT WHAT PEOPLE WANT,

944
00:34:32,392 --> 00:34:33,860
WHY PEOPLE COME TO THE DOCTORS,

945
00:34:33,860 --> 00:34:35,361
WHY PEOPLE COME TO THE CLINICS,

946
00:34:35,361 --> 00:34:36,562
WHAT ARE THEY COMPLAIPING ABOUT

947
00:34:36,562 --> 00:34:37,730
AND WHAT DO THEY NEED AND I WILL

948
00:34:37,730 --> 00:34:39,799
COME BACK TO THAT BECAUSE I WANT

949
00:34:39,799 --> 00:34:41,300
TO TALK ABOUT CHOICE AND WHY

950
00:34:41,300 --> 00:34:43,403
IT'S IMPORTANT EVEN WHEN YOU

951
00:34:43,403 --> 00:34:44,404
THINK YOU'VE FIGURED OUT WHAT

952
00:34:44,404 --> 00:34:46,439
THE MAGIC SHOT IS, YOU STILL

953
00:34:46,439 --> 00:34:48,174
NEED TO MEET PEOPLE WHERE

954
00:34:48,174 --> 00:34:52,678
THEY'RE AT AND I FEEL QUITE

955
00:34:52,678 --> 00:34:53,479
STRONGLY ABOUT THAT.

956
00:34:53,479 --> 00:34:54,547
AND WE'LL BE INTERESTED TO HEAR

957
00:34:54,547 --> 00:34:56,682
YOUR THOUGHTS ABOUT THAT AS

958
00:34:56,682 --> 00:34:56,949
WELL.

959
00:34:56,949 --> 00:34:59,018
I WANT TO SHOW THIS BECAUSE WE

960
00:34:59,018 --> 00:35:00,353
FINALLY PUBLISHED DATA RELATIVE

961
00:35:00,353 --> 00:35:03,356
TO THIS, SINCE THE LAST TIME I

962
00:35:03,356 --> 00:35:05,658
SPOKE TO ABOUT THIS.

963
00:35:05,658 --> 00:35:07,493
IT'S JUST A REMINDER THAT IF YOU

964
00:35:07,493 --> 00:35:09,762
LOOK AT THE VAGINAL MICROBIOME

965
00:35:09,762 --> 00:35:11,931
HAVING A HEALTHY LACTIC

966
00:35:11,931 --> 00:35:13,566
ACIDOSEIS ON BACILLUS

967
00:35:13,566 --> 00:35:21,340
[INDISCERNIBLE] DOMINATED MIKE

968
00:35:21,340 --> 00:35:23,342
ARE -- MICROBIOME FOR GREAT

969
00:35:23,342 --> 00:35:23,976
PROTECTION AGAINST ACQUISITION

970
00:35:23,976 --> 00:35:26,412
OF HIV AND OTHER SUCCESSESSUALLY

971
00:35:26,412 --> 00:35:26,913
TRANSMITTED INFECTIONS.

972
00:35:26,913 --> 00:35:27,847
SOME PEOPLE CALL TAKEN--THEY A

973
00:35:27,847 --> 00:35:29,449
COMMUNITY TYPE 1 BUT IT'S JUST A

974
00:35:29,449 --> 00:35:30,650
VERY GOOD PLACE TO BE AS OSHES

975
00:35:30,650 --> 00:35:33,086
POSE TO HAVING A DIVERSITY OF

976
00:35:33,086 --> 00:35:34,220
PREDOMINANTLY ANAROBES ON THE

977
00:35:34,220 --> 00:35:35,655
OTHER END OF THE SPECTRUM AND

978
00:35:35,655 --> 00:35:38,157
THIS WAS SWRUOF THE SOME DATA

979
00:35:38,157 --> 00:35:42,595
FROM A VERY EARLY STUDY, DONE BY

980
00:35:42,595 --> 00:35:46,132
DOUG QUAN AND THE FRESH COHORT

981
00:35:46,132 --> 00:35:48,134
AT HARVARD, LOOKING THE RATES OF

982
00:35:48,134 --> 00:35:49,769
HIV ACQUISITION IN YOUNG WOMEN

983
00:35:49,769 --> 00:35:53,539
AND SOUTH AFRICA, THIS WAS PRIOR

984
00:35:53,539 --> 00:35:54,674
TO PREP BECOMING AVAILABLE AND

985
00:35:54,674 --> 00:35:58,077
SO THE INCIDENCE AS YOU CAN SEE

986
00:35:58,077 --> 00:36:00,379
THERE, WAS QUITE HIGH IN THE

987
00:36:00,379 --> 00:36:03,983
WOMEN WHO HAD THE MOST DISRUPTED

988
00:36:03,983 --> 00:36:06,719
VAGINAL FLORA, THE CT4 GROUP,

989
00:36:06,719 --> 00:36:11,424
ACTUALLY, YOU CAN SEE THAT ABOUT

990
00:36:11,424 --> 00:36:12,792
12% OF THOSE PEOPLE ACQUIRED

991
00:36:12,792 --> 00:36:13,192
HIV.

992
00:36:13,192 --> 00:36:17,363
IF THEY HAD A COMPLETELY NORMAL

993
00:36:17,363 --> 00:36:19,499
VAGINAL MICROBIOME, THEY SAW NO

994
00:36:19,499 --> 00:36:20,433
HIV ACQUISITIONS, INTERESTINGLY

995
00:36:20,433 --> 00:36:22,068
ENOUGH, SO NOT A CONTROLLED

996
00:36:22,068 --> 00:36:23,703
STUDY BUT A NICE OBSERVATIONAL

997
00:36:23,703 --> 00:36:24,070
STUDY.

998
00:36:24,070 --> 00:36:25,905
WHAT'S NEW AND I SHOULD SAY IT'S

999
00:36:25,905 --> 00:36:27,673
JUST BEEN PUBLISHED IN JID IS

1000
00:36:27,673 --> 00:36:29,709
THAT WE HAVE HAD THE OPPORTUNITY

1001
00:36:29,709 --> 00:36:35,248
TO LACK MORE DEEPLY AT WHAT IS

1002
00:36:35,248 --> 00:36:37,316
GOING ON IN THOSE VAGINAL MICAH

1003
00:36:37,316 --> 00:36:38,417
ROUGH ATOM BIOME SAMPLES AND

1004
00:36:38,417 --> 00:36:40,019
THIS IS A STUDY WE WERE INVOLVED

1005
00:36:40,019 --> 00:36:41,654
IN CALL THE VOICE TRIAL WHERE WE

1006
00:36:41,654 --> 00:36:44,157
LOOKED AT THE LIKELIHOOD OF

1007
00:36:44,157 --> 00:36:46,792
WOMEN ACQUIRING HIV BY WHAT

1008
00:36:46,792 --> 00:36:48,628
THEIR VAGINAL BACTERIA LOOKED

1009
00:36:48,628 --> 00:36:48,828
LIKE.

1010
00:36:48,828 --> 00:36:52,732
IT'S A VERY COMPLICATED ANALYSIS

1011
00:36:52,732 --> 00:36:54,734
BECAUSE OF COURSE, HAVE YOU MANY

1012
00:36:54,734 --> 00:36:57,069
COMPARISONS, GOING ON HERE, BUT

1013
00:36:57,069 --> 00:37:00,506
THE BOTTOM LINE IS THAT YOU CAN

1014
00:37:00,506 --> 00:37:03,342
SHOW, EVEN WHEN YOU'VE GOT

1015
00:37:03,342 --> 00:37:09,882
MULTIPLE COMPARISONS, THAT

1016
00:37:09,882 --> 00:37:11,317
HAVING A LACTOBACILLUS DOMINANT

1017
00:37:11,317 --> 00:37:15,688
AT THE HIGH AT THE TOP IS

1018
00:37:15,688 --> 00:37:16,656
MARKEDLY PROTECTIVE AGAINST

1019
00:37:16,656 --> 00:37:18,191
GETTING HIV AND THERE WERE

1020
00:37:18,191 --> 00:37:20,226
SEVERAL BACTERIA THAT WERE

1021
00:37:20,226 --> 00:37:22,428
STRONGLY ASSOCIATED WITH

1022
00:37:22,428 --> 00:37:23,196
INCREASED LIKELIHOOD ESPECIALLY

1023
00:37:23,196 --> 00:37:28,601
AT HIGH LEVELS OF GETTING HIV,

1024
00:37:28,601 --> 00:37:29,502
PARTICULARLY MICROPLASMA

1025
00:37:29,502 --> 00:37:31,137
HOMINIDS, SOMETHING CALLED

1026
00:37:31,137 --> 00:37:33,639
SPHERE O TYPE 2, LEPTOTRICKIA

1027
00:37:33,639 --> 00:37:34,173
AND [INDISCERNIBLE].

1028
00:37:34,173 --> 00:37:35,975
WHICH IS AN INTERESTING BUG

1029
00:37:35,975 --> 00:37:40,446
BECAUSE IT'S BEEN LINKED TO SOME

1030
00:37:40,446 --> 00:37:43,082
OTHER ADVERSE EFFECTS IN THE

1031
00:37:43,082 --> 00:37:44,116
FEMALE REPRODUCTIVE TRACT AND

1032
00:37:44,116 --> 00:37:45,585
OTHER PLAYERS HERE THAT YOU

1033
00:37:45,585 --> 00:37:49,222
PROBABLY HAVE NEVER HEARD OF.

1034
00:37:49,222 --> 00:37:49,488
EXCUSE ME.

1035
00:37:49,488 --> 00:37:54,460
AGAIN, PROBABLY A MARKER FOR A

1036
00:37:54,460 --> 00:37:55,027
REALLY SUBOPTIMAL VAGINAL

1037
00:37:55,027 --> 00:37:55,428
MICROENVIRONMENT.

1038
00:37:55,428 --> 00:37:57,563
SO THAT BEGS THE QUESTION OF

1039
00:37:57,563 --> 00:37:58,931
WHETHER YOU CAN CHANGE THAT

1040
00:37:58,931 --> 00:37:59,999
ENVIRONMENT AND AGAIN, I WILL

1041
00:37:59,999 --> 00:38:01,400
BRING THIS TOGETHER, I PROMISE

1042
00:38:01,400 --> 00:38:07,139
IT'S NOT A TOTAL DIVERSE, EXCUSE

1043
00:38:07,139 --> 00:38:09,108
ME, SO REMEMBER THAT VAGINAL

1044
00:38:09,108 --> 00:38:10,610
COMPLAINTS ARE PROBABLY THE

1045
00:38:10,610 --> 00:38:12,578
BIGGEST REASON WOMEN COME TO

1046
00:38:12,578 --> 00:38:15,281
SEEK CARE IN CLINICS IN THE

1047
00:38:15,281 --> 00:38:17,783
U.S., CERTAINLY, AND SO, WE

1048
00:38:17,783 --> 00:38:19,652
ASKED THE QUESTION ABOUT WHETHER

1049
00:38:19,652 --> 00:38:22,121
YOU COULD MODIFY THE VAGINAL

1050
00:38:22,121 --> 00:38:26,659
MICROBIOME TO MAKE IT MORE

1051
00:38:26,659 --> 00:38:28,628
LACTOBACILLUS PREDOMINANT, AND

1052
00:38:28,628 --> 00:38:33,466
ACTUALLY RANDOMIZE WOMEN TO

1053
00:38:33,466 --> 00:38:35,935
SOMETHING CALLED THE NUVU RING,

1054
00:38:35,935 --> 00:38:38,437
WHICH HAS ESTRO GENERATED AND

1055
00:38:38,437 --> 00:38:41,607
PROGUEST ROAN, WE KNOW ESTROGEN

1056
00:38:41,607 --> 00:38:43,276
IS A PROMOTER OF LACTOBACILLUS,

1057
00:38:43,276 --> 00:38:45,278
THEY LOVE AN ESTROGEN RICH

1058
00:38:45,278 --> 00:38:47,013
ENVIRONMENT AND WE LOOKED AT

1059
00:38:47,013 --> 00:38:49,248
CONTINUOUS USE WHICH YOU CAN DO

1060
00:38:49,248 --> 00:38:52,485
IN ORDER TO SUPPRESS MENESES OR

1061
00:38:52,485 --> 00:38:54,120
CYCLIC USE WHICH IS HOW THE RING

1062
00:38:54,120 --> 00:38:57,957
IS ACTUALLY SUPPOSED TO BE

1063
00:38:57,957 --> 00:38:58,724
PRESCRIBED BECAUSE TECHNICALLY

1064
00:38:58,724 --> 00:39:01,661
YOU TAKE THE RING OUT AND MEN

1065
00:39:01,661 --> 00:39:03,129
STRAIGHT, MOST WOMEN LEAVE IT IN

1066
00:39:03,129 --> 00:39:04,964
AND NOT MEN STRAIGHT BECAUSE

1067
00:39:04,964 --> 00:39:05,598
THEY WOULD RATHER FOCUS ON THE

1068
00:39:05,598 --> 00:39:06,465
MEN STRAIGHT.

1069
00:39:06,465 --> 00:39:07,667
THE BOTTOM LINE IS WHAT WE

1070
00:39:07,667 --> 00:39:09,869
SHOWED AND THIS IS I THINK

1071
00:39:09,869 --> 00:39:11,971
FASCINATING WHEN YOU THINK AGAIN

1072
00:39:11,971 --> 00:39:12,538
ABOUT OFFERING WOMEN CHOICE.

1073
00:39:12,538 --> 00:39:15,341
WE HAVE A RING FOR PREVENTION OF

1074
00:39:15,341 --> 00:39:16,142
HIV.

1075
00:39:16,142 --> 00:39:17,343
IT'S CALLED THE [INDISCERNIBLE].

1076
00:39:17,343 --> 00:39:19,912
ARE WOMEN GOING TO USE A RING

1077
00:39:19,912 --> 00:39:21,280
JUST TO PREVENT HIV OR MAYBE

1078
00:39:21,280 --> 00:39:22,682
WOULD THEY LIKE A RING THAT

1079
00:39:22,682 --> 00:39:24,016
PREVENTS HIV AND ALSO PREVENT

1080
00:39:24,016 --> 00:39:26,519
THEM FROM HAVING THEIR PERIODS

1081
00:39:26,519 --> 00:39:29,822
AND ALSO MAYBE PREVENT THEM FROM

1082
00:39:29,822 --> 00:39:30,923
HAVING BACTERIAL VAJINOSEIS

1083
00:39:30,923 --> 00:39:32,858
WHICH 60% OF THE WOMEN WHO CAME

1084
00:39:32,858 --> 00:39:36,262
TO OUR STUDY IN KENYA HAD ON

1085
00:39:36,262 --> 00:39:37,563
EVALUATION AND MOST WERE

1086
00:39:37,563 --> 00:39:39,265
SYMPTOMATIC, SO THE BOTTOM LINE

1087
00:39:39,265 --> 00:39:45,471
HERE IS THAT IF YOU USED RING

1088
00:39:45,471 --> 00:39:49,575
CONTINUOUSLY, YOU MARKEDLY

1089
00:39:49,575 --> 00:39:51,110
REDUCED AND ANAROBES WHERE I

1090
00:39:51,110 --> 00:39:53,479
JUST SHOWED YOU WERE ASSOCIATE

1091
00:39:53,479 --> 00:39:55,281
WIDE AN INCREASED RISK OF EBV

1092
00:39:55,281 --> 00:39:56,749
OVER THE COURSE OF 6 MONTHS.

1093
00:39:56,749 --> 00:39:58,918
WE DID NOT HAVE ENOUGH WOMEN

1094
00:39:58,918 --> 00:40:00,553
THANKFULLY WHO HAD HIV INFECTED,

1095
00:40:00,553 --> 00:40:02,188
WE HAD NO WOMEN HIV INFEC INDEED

1096
00:40:02,188 --> 00:40:03,823
THIS STUDY SO WE COULDN'T LOOK

1097
00:40:03,823 --> 00:40:05,624
AT A PROTECTIVE EFFECT AND IT

1098
00:40:05,624 --> 00:40:07,793
WAS BT DESIGNED TO DO THAT BUT

1099
00:40:07,793 --> 00:40:09,428
IT'S A SIGNAL WITH PERHAPS THE

1100
00:40:09,428 --> 00:40:14,867
RIGHT SORT OF COMBINATION OF

1101
00:40:14,867 --> 00:40:17,436
HORMONAL MANIPULATIONS COMBINED

1102
00:40:17,436 --> 00:40:19,839
WITH AN ANTIRETROVIRAL YOU MAY

1103
00:40:19,839 --> 00:40:21,640
BE ABLE TO DELIVER INTERVENTIONS

1104
00:40:21,640 --> 00:40:22,508
AT SEVERAL LEVELS IN THEIR

1105
00:40:22,508 --> 00:40:27,346
QUALITY OF LIFE THAT WOULD

1106
00:40:27,346 --> 00:40:28,080
PREVENT HIV, IDEALLY ENHANCE

1107
00:40:28,080 --> 00:40:30,383
THEIR QUALITY OF LIFE, AND MAYBE

1108
00:40:30,383 --> 00:40:34,086
EVEN SOLVE SOME OF THE PROBLEMS

1109
00:40:34,086 --> 00:40:36,889
OF VAGINAL INFECTIONS WHICH ARE

1110
00:40:36,889 --> 00:40:38,190
QUITE SUBSTANTIAL IN SUB-SAHARAN

1111
00:40:38,190 --> 00:40:38,424
AFRICA.

1112
00:40:38,424 --> 00:40:42,495
THERE ARE DATA TO SAY THAT

1113
00:40:42,495 --> 00:40:44,463
BACTERIAL VAJINOSEIS OR

1114
00:40:44,463 --> 00:40:45,564
ANAEROBIC PREDOMINANCE OF THE

1115
00:40:45,564 --> 00:40:47,666
VARMIS BEGINNA IS RESPONSIBLE

1116
00:40:47,666 --> 00:40:49,735
FOR ABOUT 22% OF THE POPULATION

1117
00:40:49,735 --> 00:40:51,036
ATTRIBUTE AUTOMOBILE RISK FOR

1118
00:40:51,036 --> 00:40:52,104
HIV INFECTION JUST BECAUSE IT'S

1119
00:40:52,104 --> 00:40:53,105
SO PREVALENT AND WHEN YOU TAKE

1120
00:40:53,105 --> 00:40:55,408
ARK WAY ALL THE OTHER STIs,

1121
00:40:55,408 --> 00:40:56,842
THAT'S REALLY THE ONLY OTHER

1122
00:40:56,842 --> 00:40:58,043
THING THAT REMAINS, SO THOSE

1123
00:40:58,043 --> 00:40:59,512
DATA REALLY SUPPORT THAT, SO IT

1124
00:40:59,512 --> 00:41:00,546
SHOWS THERE'S SOMETHING IN THE

1125
00:41:00,546 --> 00:41:01,614
ENVIRONMENT THAT IS REALLY

1126
00:41:01,614 --> 00:41:02,481
SUPPORTIVE.

1127
00:41:02,481 --> 00:41:04,917
SO LET'S GET BACK TO HIV

1128
00:41:04,917 --> 00:41:06,285
PREEXPOSURE PROPHYLAXIS WITH

1129
00:41:06,285 --> 00:41:07,353
THAT BACKGROUND.

1130
00:41:07,353 --> 00:41:10,022
I REALLY LIKED THIS ARTICLE IN

1131
00:41:10,022 --> 00:41:11,357
THE LANCET HIV, AND AGAIN, IT

1132
00:41:11,357 --> 00:41:14,727
GETS TO THIS ISSUE OF HOW WE

1133
00:41:14,727 --> 00:41:19,298
CONTINUE TO TALK ABOUT PEOPLE AT

1134
00:41:19,298 --> 00:41:21,967
RISK AND HOW PEOPLE

1135
00:41:21,967 --> 00:41:23,436
QUOTE-UNQUOTE AT RISK ARE

1136
00:41:23,436 --> 00:41:23,769
DEFINED.

1137
00:41:23,769 --> 00:41:24,837
WE HAD THIS SORT OF THEY--THE

1138
00:41:24,837 --> 00:41:26,472
RETINAL LOCATIONERAL IDEA THAT

1139
00:41:26,472 --> 00:41:28,174
BY 2030 WE MIGHT BE ABLE TO

1140
00:41:28,174 --> 00:41:28,674
CONTROL HIV.

1141
00:41:28,674 --> 00:41:31,010
I DON'T THINK THAT'S REALISTIC

1142
00:41:31,010 --> 00:41:33,879
BASED ON WHAT WE HAVE BEEN

1143
00:41:33,879 --> 00:41:36,682
TALKING ABOUT TODAY.

1144
00:41:36,682 --> 00:41:39,051
AND I DON'T THINK IT'S REALISTIC

1145
00:41:39,051 --> 00:41:40,352
BECAUSE AS THIS ARTICLE POINTS

1146
00:41:40,352 --> 00:41:42,888
OUT MANY NEW INFECTIONS ARE IN

1147
00:41:42,888 --> 00:41:45,124
PEOPLE WHO DON'T CLASSIFY

1148
00:41:45,124 --> 00:41:46,659
THEMSELVES AS QUOTE-UNQUOTE HIGH

1149
00:41:46,659 --> 00:41:47,526
RISK AND YOU REALLY HAVE TO

1150
00:41:47,526 --> 00:41:49,328
THINK ABOUT WHAT YOU MEAN WHEN

1151
00:41:49,328 --> 00:41:51,597
YOU TALK ABOUT THAT.

1152
00:41:51,597 --> 00:41:53,566
I THINK ABOUT IT AS THOSE PEOPLE

1153
00:41:53,566 --> 00:41:56,502
WHO ARE NOT PRIORITIZED FOR

1154
00:41:56,502 --> 00:41:57,203
PREVENTION INTERVENTIONS.

1155
00:41:57,203 --> 00:41:59,271
SO THERE ARE PEOPLE WHO MAY BE

1156
00:41:59,271 --> 00:42:01,674
HAVE 1 PARTNER AND THEIR PARTNER

1157
00:42:01,674 --> 00:42:03,108
IS THE SOURCE OF THEIR HIV

1158
00:42:03,108 --> 00:42:04,977
INFECTION OF COURSE BECAUSE THEY

1159
00:42:04,977 --> 00:42:07,213
HAVE MORE PARTNERS.

1160
00:42:07,213 --> 00:42:10,549
SO THIS IDEA OF HAVING SOME

1161
00:42:10,549 --> 00:42:11,817
CONCEPT OF POPULATION LEVEL

1162
00:42:11,817 --> 00:42:13,986
BASED CONTROL AGAIN THINK BEING

1163
00:42:13,986 --> 00:42:14,987
DEVELOPING INTERVENTIONS THAT

1164
00:42:14,987 --> 00:42:17,156
ARE DESIGNED TO MEET PEOPLE

1165
00:42:17,156 --> 00:42:17,857
WHERE THEY'RE AT.

1166
00:42:17,857 --> 00:42:18,958
WHETHER THEY THINK THEY'RE HIGH

1167
00:42:18,958 --> 00:42:20,826
RISK OR NOT, WHETHER THEY WILL

1168
00:42:20,826 --> 00:42:23,529
GO IN FOR AN EVERY 6 MONTH

1169
00:42:23,529 --> 00:42:25,764
INJECTION OR NOT, I THINK IS

1170
00:42:25,764 --> 00:42:26,131
VERY IMPORTANT.

1171
00:42:26,131 --> 00:42:28,400
SO I KNOW THAT WE STILL NEED TO

1172
00:42:28,400 --> 00:42:31,103
FOCUS ON THE HIGH INCIDENCE

1173
00:42:31,103 --> 00:42:32,204
COUNTIES RIGHT, WE STILL HAVE A

1174
00:42:32,204 --> 00:42:35,274
BIG NEED IN THE HIV EPIDEMIC,

1175
00:42:35,274 --> 00:42:38,878
THAT'S NO QUESTION, BUT, I THINK

1176
00:42:38,878 --> 00:42:42,815
THAT HAVING THIS MORE GLOBAL

1177
00:42:42,815 --> 00:42:44,450
CONCEPT OF PEOPLE AT

1178
00:42:44,450 --> 00:42:46,218
QUOTE-UNQUOTE INCREASED RISK IS

1179
00:42:46,218 --> 00:42:49,054
GOING TO REALLY BE IMPORTANT.

1180
00:42:49,054 --> 00:42:53,792
SO LET'S TALK A FEW THINGS, I

1181
00:42:53,792 --> 00:42:56,595
WILL NOT TALK ABOUT VACCINES OR

1182
00:42:56,595 --> 00:42:57,496
BROADLY NEUTRALIZING ANTIBODIES

1183
00:42:57,496 --> 00:43:03,135
I REALLY WANT TO TALK ABOUT AS

1184
00:43:03,135 --> 00:43:04,670
MY TITLE MENTIONED PROPHYLAXIS

1185
00:43:04,670 --> 00:43:06,705
AND I HOPEFULLY YOU SAW THAT

1186
00:43:06,705 --> 00:43:07,940
ARTICLE IN THE NEW ENGLAND

1187
00:43:07,940 --> 00:43:10,209
JOURNAL OF MEDICINE AND

1188
00:43:10,209 --> 00:43:17,082
PRESENTED  MUNICH FOR PRESENTATS

1189
00:43:17,082 --> 00:43:19,785
SHOWING THAT TWICE YEARLY

1190
00:43:19,785 --> 00:43:20,719
INJECTIONS OF LANACAPPA VIR,

1191
00:43:20,719 --> 00:43:23,822
WITH A SAP SID ASSEMBLY

1192
00:43:23,822 --> 00:43:24,623
INHIBITOR, TOTALLY NEW CLASS

1193
00:43:24,623 --> 00:43:25,691
WHICH IS AVAILABLE FOR TREATMENT

1194
00:43:25,691 --> 00:43:27,760
IN THE UNITED STATES AT A COST

1195
00:43:27,760 --> 00:43:32,164
OF, ANYBODY KNOW WHAT IT COSTS

1196
00:43:32,164 --> 00:43:37,269
TO GET LENACOP A VIR, ANYONE

1197
00:43:37,269 --> 00:43:40,139
KNOW HOW MUCH CONTREATMENT

1198
00:43:40,139 --> 00:43:40,506
COSTS?

1199
00:43:40,506 --> 00:43:41,140
$42,000.

1200
00:43:41,140 --> 00:43:43,976
THIS WAS STUDIED IN CISGENDER

1201
00:43:43,976 --> 00:43:46,579
WOMEN IN KENYA, UGANDA AND SOUTH

1202
00:43:46,579 --> 00:43:49,782
AFRICA AND THE STUDY WAS STOPPED

1203
00:43:49,782 --> 00:43:53,986
EARLY BECAUSE THE DSMB NOTE THAD

1204
00:43:53,986 --> 00:43:54,887
THERE WERE 0 INFECTIONS IN THE

1205
00:43:54,887 --> 00:43:59,992
GROUP THAT WAS RANDOMIZED TO

1206
00:43:59,992 --> 00:44:02,595
LENACAPP A VIR, THE BACKGROUND

1207
00:44:02,595 --> 00:44:03,896
GROUPS ARE CONFUSING WOMEN WERE

1208
00:44:03,896 --> 00:44:07,266
EITHER GIVEN -- IT WAS BLINDED

1209
00:44:07,266 --> 00:44:10,035
SO THEY WERE GIVEN EITHER ACTIVE

1210
00:44:10,035 --> 00:44:16,275
ORAL TAF BASED PREVENTION OR

1211
00:44:16,275 --> 00:44:17,910
ORAL LENACAPP A VIR INJECTIONS

1212
00:44:17,910 --> 00:44:22,081
AND IN THE GROUP THAT USED ORAL

1213
00:44:22,081 --> 00:44:26,018
LENACAPP A VIR, ONLY 1-2%

1214
00:44:26,018 --> 00:44:26,352
ACQUIRED HIV.

1215
00:44:26,352 --> 00:44:28,654
I THINK THIS STUDY IS

1216
00:44:28,654 --> 00:44:29,521
FASCINATING BECAUSE WE'RE NOW

1217
00:44:29,521 --> 00:44:30,856
LOOKING AT A STUDY WHERE YOU

1218
00:44:30,856 --> 00:44:31,757
ESTABLISHED 0 BASE LINE FOR WHAT

1219
00:44:31,757 --> 00:44:32,992
YOU THINK SHOULD BE HAPPENING IN

1220
00:44:32,992 --> 00:44:34,026
PREVENTION WHICH IS GOING TO

1221
00:44:34,026 --> 00:44:36,495
MAKE IT VERY HARD TO STUDY

1222
00:44:36,495 --> 00:44:37,596
ANYTHING IF YOU'RE NOT GOING TO

1223
00:44:37,596 --> 00:44:41,734
USE A DESIGN LIKE THIS.

1224
00:44:41,734 --> 00:44:42,801
IT'S A COMPLICATED DESIGN.

1225
00:44:42,801 --> 00:44:44,603
WHAT THEY DID TO DO THIS AND IF

1226
00:44:44,603 --> 00:44:46,205
THERE ARE STATISTICIANS IN THE

1227
00:44:46,205 --> 00:44:47,039
ROOM, THEY CAN EXPLAIN THIS

1228
00:44:47,039 --> 00:44:48,374
BETTER THAN I CAN, THEY

1229
00:44:48,374 --> 00:44:49,575
ESTABLISHED THE BASE LINE

1230
00:44:49,575 --> 00:44:51,043
PREVALENCE OR WHAT YOU WOULD

1231
00:44:51,043 --> 00:44:53,846
HAVE EXPECTED IN THE CONTEXT OF

1232
00:44:53,846 --> 00:44:55,581
A PLACEBO, BY TAKING ALL THE

1233
00:44:55,581 --> 00:44:57,282
PEOPLE WHO TESTED POSITIVE WHEN

1234
00:44:57,282 --> 00:44:58,384
THEY COME IN TO BE SCREENED FOR

1235
00:44:58,384 --> 00:45:02,121
THE STUDY AND DOING A RECENTSY

1236
00:45:02,121 --> 00:45:03,656
ASSAY AND LOOKING AT THE LIKELY

1237
00:45:03,656 --> 00:45:05,891
INCIDENCE OVER THE LAST 6 MONTHS

1238
00:45:05,891 --> 00:45:09,328
IN PEOPLE WHO WERE MOST LIKELY

1239
00:45:09,328 --> 00:45:10,229
RECENTLY INFECTED.

1240
00:45:10,229 --> 00:45:12,364
AND THAT'S WHERE THEY GOT THE

1241
00:45:12,364 --> 00:45:13,799
BASE LINE THAT THEY USE FOR

1242
00:45:13,799 --> 00:45:15,034
COMPARISON.

1243
00:45:15,034 --> 00:45:16,402
I THINK THAT'S THE ONLY WAY WE

1244
00:45:16,402 --> 00:45:17,736
WILL BE ABLE TO DO STUDIES IN

1245
00:45:17,736 --> 00:45:19,338
THE FUTURE SO IF YOU DON'T

1246
00:45:19,338 --> 00:45:20,272
UNDERSTAND IT, IT'S WORTH TAKING

1247
00:45:20,272 --> 00:45:22,174
A QUICK LOOK AND READING UP

1248
00:45:22,174 --> 00:45:22,741
ABOUT IT.

1249
00:45:22,741 --> 00:45:25,477
IT'S QUITE FASCINATING. 

1250
00:45:25,477 --> 00:45:26,378
SO BOTTOM LINE, 0 INFECTIONS IN

1251
00:45:26,378 --> 00:45:31,083
THE WOMEN IN THIS STUDY.

1252
00:45:31,083 --> 00:45:33,052
SO THE UNAIDS EXECUTIVE DIRECTOR

1253
00:45:33,052 --> 00:45:34,887
CALLED IT A MIRACLE PREVENTION

1254
00:45:34,887 --> 00:45:35,120
TOOL.

1255
00:45:35,120 --> 00:45:36,455
THERE WERE PEOPLE DEMONSTRATING

1256
00:45:36,455 --> 00:45:37,956
AS THEY DO AT THE INTERNATIONAL

1257
00:45:37,956 --> 00:45:39,158
AIDS SOCIETY MEETING FOR GILLIAD

1258
00:45:39,158 --> 00:45:43,028
TO GET THIS OUT THERE YESTERDAY

1259
00:45:43,028 --> 00:45:44,663
DESPITE THE FACT THAT THE STUDY

1260
00:45:44,663 --> 00:45:49,168
WAS BEING PRESENTED AT THE

1261
00:45:49,168 --> 00:45:51,870
MUNICH MEETING AND JUST BEFORE

1262
00:45:51,870 --> 00:45:53,672
THE LIMA, PERU MEETING, THE

1263
00:45:53,672 --> 00:45:55,107
PURPOSE 2 TRIAL CAME OUT AND

1264
00:45:55,107 --> 00:45:59,445
THIS WAS A STUDY AMONG GAY MEN,

1265
00:45:59,445 --> 00:46:00,279
TRANSAND NONBINARY PEOPLE.

1266
00:46:00,279 --> 00:46:04,183
THIS HAS NOT BEEN PUBLISHED YET,

1267
00:46:04,183 --> 00:46:08,087
BUT THIS WAS AGAIN IN A

1268
00:46:08,087 --> 00:46:09,021
DIFFERENT POPULATION, ABOUT 3200

1269
00:46:09,021 --> 00:46:13,525
PEOPLE AND AMONG MORE THAN 2000

1270
00:46:13,525 --> 00:46:15,861
PEOPLE WHO RECEIVED LENACAPP A

1271
00:46:15,861 --> 00:46:19,498
VIR, THERE WERE ONLY 2 HIV

1272
00:46:19,498 --> 00:46:20,532
INFECTIONS AND IN THOSE PEOPLE

1273
00:46:20,532 --> 00:46:22,367
THERE WAS A SUGGESTION THAT THAT

1274
00:46:22,367 --> 00:46:23,736
WAS NOT TOTALLY SURPRISING.

1275
00:46:23,736 --> 00:46:26,772
WE DON'T KNOW THE DETAILS YET.

1276
00:46:26,772 --> 00:46:29,241
THIS IS NOT BEEN PUBLISHED TO MY

1277
00:46:29,241 --> 00:46:33,645
KNOWLEDGE YET. 

1278
00:46:33,645 --> 00:46:36,281
SO, AGAIN, 99.9% OF PEOPLE DID

1279
00:46:36,281 --> 00:46:37,449
NOT ACQUIRE HIV INFECTION.

1280
00:46:37,449 --> 00:46:42,221
AND IN THE TENAFAVIR GROUP, IT

1281
00:46:42,221 --> 00:46:43,756
WAS SIMILAR, AGAIN THIS IS A

1282
00:46:43,756 --> 00:46:45,090
PRESS RELEASE TO WHAT I SHOWED

1283
00:46:45,090 --> 00:46:45,991
TO THE PURPOSE 1 TRIAL EMPLOY SO

1284
00:46:45,991 --> 00:46:47,993
THIS WAS STOPPED BY THE DSMB,

1285
00:46:47,993 --> 00:46:52,564
AND IF YOU LOOK AT WHAT THE

1286
00:46:52,564 --> 00:46:55,934
LANDSCAPE OF THE FUTURE STUDIES

1287
00:46:55,934 --> 00:46:58,637
FOR LENACAPP A VIR HERE, WHAT WE

1288
00:46:58,637 --> 00:46:59,972
TALKED ABOUT PURPOSE 1, 2, 3,

1289
00:46:59,972 --> 00:47:02,341
WAS TO BE IN CISGENDER WOMEN IN

1290
00:47:02,341 --> 00:47:03,776
THE UNITED STATES, PURPOSE 4 WAS

1291
00:47:03,776 --> 00:47:06,145
TO BE IN PEOPLE WHO INJECT DRUGS

1292
00:47:06,145 --> 00:47:10,382
AND PURPOSE 5 WAS GOING TO BE

1293
00:47:10,382 --> 00:47:12,217
LARGER STUDY IN CISGENDER MEN

1294
00:47:12,217 --> 00:47:14,920
WHO HAVE SEX WITH MEN

1295
00:47:14,920 --> 00:47:17,222
TRANSGENDER MEN AND WOMEN AND

1296
00:47:17,222 --> 00:47:17,456
BINARY.

1297
00:47:17,456 --> 00:47:20,526
IT'S NOT CLEAR WHAT THESE

1298
00:47:20,526 --> 00:47:22,628
STUDIES WILL LOOK LIKE NOW GIVEN

1299
00:47:22,628 --> 00:47:24,897
THE ROBUST FINDING OF THE 2

1300
00:47:24,897 --> 00:47:25,998
TRIALS AND GILLIAD ALREADY

1301
00:47:25,998 --> 00:47:28,834
SUBMITTED OR IS READ READY TO

1302
00:47:28,834 --> 00:47:29,735
SUBMIT FOR REGULATORY APPROVAL

1303
00:47:29,735 --> 00:47:31,036
SO THE QUESTION SOPHISTICATED

1304
00:47:31,036 --> 00:47:33,505
EVERYBODY'S MIND IS IS IT TIME

1305
00:47:33,505 --> 00:47:34,039
TO DECLARE VICTORY.

1306
00:47:34,039 --> 00:47:36,675
DO WE HAVE A PRODUCT YOU CAN

1307
00:47:36,675 --> 00:47:39,044
JUST GIVE PEOPLE EVERY 6 MONTHS

1308
00:47:39,044 --> 00:47:41,046
AND SAY WHY DO WE EVEN NEED TO

1309
00:47:41,046 --> 00:47:42,881
WORK ON AN HIV VACCINE, AND

1310
00:47:42,881 --> 00:47:45,317
THAT'S REALLY THE BIG QUESTION.

1311
00:47:45,317 --> 00:47:49,555
SO MY JOB HERE IS TO CAST SOME

1312
00:47:49,555 --> 00:47:53,458
DOUBT ON THIS ROSIE SCENARIO.

1313
00:47:53,458 --> 00:47:57,863
I THINK THAT YOU MAY BE FAMILIAR

1314
00:47:57,863 --> 00:47:59,298
WITH EYOR, THE CHARACTER WHO'S

1315
00:47:59,298 --> 00:48:02,367
ALWAYS COMING UP WITH REASONS TO

1316
00:48:02,367 --> 00:48:03,135
BE NOT OPTIMISTIC, SO I LISTED

1317
00:48:03,135 --> 00:48:04,603
SOME OF THE REASONS THAT I JUST

1318
00:48:04,603 --> 00:48:06,171
THINK WE NEED TO PAY ATTENTION

1319
00:48:06,171 --> 00:48:06,605
TO.

1320
00:48:06,605 --> 00:48:11,310
FIRST OF ALL RESISTANCE

1321
00:48:11,310 --> 00:48:12,744
MUTATIONS, TIME TO MARKET,

1322
00:48:12,744 --> 00:48:13,979
ACCESS, COST, DEMAND AND

1323
00:48:13,979 --> 00:48:14,413
DELIVERY STRUCTURE.

1324
00:48:14,413 --> 00:48:15,781
SO LET ME TALK ABOUT THOSE

1325
00:48:15,781 --> 00:48:16,148
REALLY QUICKLY.

1326
00:48:16,148 --> 00:48:18,450
WE DO HAVE A LONG ACTING

1327
00:48:18,450 --> 00:48:23,655
INJECTABLE FOR HIV, LONG ACTING

1328
00:48:23,655 --> 00:48:24,957
CAPP A TEGAVIR, IT'S OUT THERE,

1329
00:48:24,957 --> 00:48:25,958
AVAILABLE, AND TOUGH FOR PEOPLE

1330
00:48:25,958 --> 00:48:27,626
TO GET IT AND GET IT PAID FOR.

1331
00:48:27,626 --> 00:48:29,161
IT DOES WORK VERY WELL, THE

1332
00:48:29,161 --> 00:48:32,030
EFFICACY FOR LONG ACTING CAB, IT

1333
00:48:32,030 --> 00:48:32,397
WAS ABOUT 93%.

1334
00:48:32,397 --> 00:48:36,668
, SO NOT QUITE AS HIGH AS

1335
00:48:36,668 --> 00:48:40,005
LENACAPP A VIR, BUT REALLY, VERY

1336
00:48:40,005 --> 00:48:40,205
GOOD.

1337
00:48:40,205 --> 00:48:41,707
THE PROBLEM IS WE HAVE ALREADY

1338
00:48:41,707 --> 00:48:46,478
SEEN A CASE OF CABOTEGRAVIR, IN

1339
00:48:46,478 --> 00:48:48,580
A PERSON WHO CLEARLY GOT THE

1340
00:48:48,580 --> 00:48:49,514
RESISTANCE WHILE THEY WERE ON

1341
00:48:49,514 --> 00:48:50,883
THE DRUG AND THAT'S THE KEY

1342
00:48:50,883 --> 00:48:52,818
THING, THIS WAS NOT JUST A

1343
00:48:52,818 --> 00:48:56,889
MATTER OF DELAYED DETECTION

1344
00:48:56,889 --> 00:48:58,156
BECAUSE DETECTING INCIDENT HIV

1345
00:48:58,156 --> 00:49:03,028
INFECTION IN LONG ACTING CAB, IS

1346
00:49:03,028 --> 00:49:03,528
INCREDIBLY COMPLICATED.

1347
00:49:03,528 --> 00:49:05,063
THE TEST RESULTINGS ARE WONKY,

1348
00:49:05,063 --> 00:49:07,633
YOU CAN'T USE RAPID HIV TESTS,

1349
00:49:07,633 --> 00:49:09,935
YOU HAVE TO DO MORE

1350
00:49:09,935 --> 00:49:10,435
SOPHISTICATED TESTING.

1351
00:49:10,435 --> 00:49:12,004
BUT THIS PERSON I LIKE TO USE,

1352
00:49:12,004 --> 00:49:14,206
AND THIS WAS JUST PUBLISHED A

1353
00:49:14,206 --> 00:49:15,040
COUPLE WEEKS AGO BECAUSE IT WAS

1354
00:49:15,040 --> 00:49:17,476
A PERSON WHO I THINK EMBODIES

1355
00:49:17,476 --> 00:49:19,111
THE CHALLENGES TO HIV PREVENTION

1356
00:49:19,111 --> 00:49:21,947
IN OUR MOST VULNERABLE PATIENTS.

1357
00:49:21,947 --> 00:49:27,519
THIS WAS A PERSON WHO WAS ABLE

1358
00:49:27,519 --> 00:49:29,855
TO GET THEIR CAB LA PREP

1359
00:49:29,855 --> 00:49:32,057
INJECTIONS BUT THEN HAD A 6

1360
00:49:32,057 --> 00:49:33,825
MONTH GAP IN CARE.

1361
00:49:33,825 --> 00:49:33,992
WHY?

1362
00:49:33,992 --> 00:49:34,960
BECAUSE THEY CHANGED INSURANCE

1363
00:49:34,960 --> 00:49:36,395
AND THE INSURANCE WOULDN'T COVER

1364
00:49:36,395 --> 00:49:38,297
IT SO FELL OUT OF CARE, CAME

1365
00:49:38,297 --> 00:49:41,533
BACK IN, HAD SOME OTHER

1366
00:49:41,533 --> 00:49:43,435
CHALLENGES WITH GETTING CAB LA,

1367
00:49:43,435 --> 00:49:44,503
THE INSURANCE PAPERWORK WAS BT

1368
00:49:44,503 --> 00:49:46,238
DONE, ALL THE THINGS THAT WE'RE

1369
00:49:46,238 --> 00:49:47,139
SO FAMILIAR WITH WHEN WE'RE

1370
00:49:47,139 --> 00:49:50,676
TRYING TO GET THINGS DONE FOR

1371
00:49:50,676 --> 00:49:51,376
OUR PATIENTS, ANYWAY, BOTTOM

1372
00:49:51,376 --> 00:49:56,381
LINE IS THIS ENDED UP IN A VERY

1373
00:49:56,381 --> 00:50:00,419
CLEAR INFECTION WITH A

1374
00:50:00,419 --> 00:50:01,653
CABOTEGRAVIR MARKER WITH THAT

1375
00:50:01,653 --> 00:50:03,522
WAS ASSOCIATE WIDE THE

1376
00:50:03,522 --> 00:50:06,658
INTERRUPTED EXPOSURE TO

1377
00:50:06,658 --> 00:50:08,927
CABOTEGRAVIR, SO AGAIN, THIS IS

1378
00:50:08,927 --> 00:50:10,462
AN IMPERFECT SITUATION BUT YOU

1379
00:50:10,462 --> 00:50:12,864
KNOW MOST LIFE SITUATIONS ARE

1380
00:50:12,864 --> 00:50:13,265
IMPERFECT.

1381
00:50:13,265 --> 00:50:14,833
LIFE IS NOT   PERFEJT.

1382
00:50:14,833 --> 00:50:17,069
MOST PATIENT'S LIVES HAVE SOME

1383
00:50:17,069 --> 00:50:19,471
ELEMENT OF CHAOS.

1384
00:50:19,471 --> 00:50:21,640
SO, AGAIN, THE DRUGS ARE ONLY

1385
00:50:21,640 --> 00:50:25,544
PERFECT WHEN YOU CAN ADMINISTER

1386
00:50:25,544 --> 00:50:27,145
THEM PERFECTLY AND MONITOR THEM

1387
00:50:27,145 --> 00:50:28,180
PERFECTLY AND I DON'T KNOW

1388
00:50:28,180 --> 00:50:28,647
THAT'S POSSIBLE.

1389
00:50:28,647 --> 00:50:29,648
THE TIME TO MARKET AND

1390
00:50:29,648 --> 00:50:31,583
DISTRIBUTION OF THESE DRUG IS A

1391
00:50:31,583 --> 00:50:32,985
REALLY BIG CHALLENGE AND IF YOU

1392
00:50:32,985 --> 00:50:35,420
ARE LOOKING AT THIS, TAKE A LOOK

1393
00:50:35,420 --> 00:50:39,024
AT THE AVERY CLOSE AK CO-WORKERS

1394
00:50:39,024 --> 00:50:40,993
SITE, THEY POINT OUT HOW LONG IT

1395
00:50:40,993 --> 00:50:44,963
TAKES FOR THIS TO GET TO MARKET.

1396
00:50:44,963 --> 00:50:46,164
CAB-A, THE COMPANY THAT STOOD IT

1397
00:50:46,164 --> 00:50:48,133
UP IN THE BEGINNING WAS

1398
00:50:48,133 --> 00:50:49,301
UNPREPARED TO GET IT OUT THERE

1399
00:50:49,301 --> 00:50:51,236
AFTER THE POSITIVE RESULTS SO

1400
00:50:51,236 --> 00:50:53,739
THERE'S BEEN A BIG LAG GETTING

1401
00:50:53,739 --> 00:50:56,475
CAB-LA OUT THERE TO PLACES THAT

1402
00:50:56,475 --> 00:50:57,109
REALLY NEED IT.

1403
00:50:57,109 --> 00:50:58,710
THE OTHER THING I WANT TO POINT

1404
00:50:58,710 --> 00:51:00,012
OUT IS THAT, YOU KNOW THESE

1405
00:51:00,012 --> 00:51:04,416
DRUGS ARE NOT GIVEN IN A VACUUM,

1406
00:51:04,416 --> 00:51:06,785
AND I AGAIN THINK ABOUT

1407
00:51:06,785 --> 00:51:09,688
SITUATIONS WHERE PEOPLE HAVE

1408
00:51:09,688 --> 00:51:10,155
ESTABLISHED EXCELLENT

1409
00:51:10,155 --> 00:51:11,523
INFRASTRUCTURES FOR CARE AND

1410
00:51:11,523 --> 00:51:13,892
REALLY HOW FRAGILE THOSE

1411
00:51:13,892 --> 00:51:15,193
INFRASTRUCTURES ARE, RIGHT?

1412
00:51:15,193 --> 00:51:17,662
SO PEOPLE ARE LIVING IN

1413
00:51:17,662 --> 00:51:18,597
SITUATIONS AND ALL YOU HAVE TO

1414
00:51:18,597 --> 00:51:21,333
DO IS LOOK AT THE NEWS TO SEE

1415
00:51:21,333 --> 00:51:22,834
WHETHER HEALTHCARE CLINICS THAT

1416
00:51:22,834 --> 00:51:24,336
HAVE BEEN BUILT UP OVER MANY

1417
00:51:24,336 --> 00:51:25,837
YEARS ARE DESTROYED AND IT'S A

1418
00:51:25,837 --> 00:51:28,206
REMIND THEY'RE TO DELIVER ANY

1419
00:51:28,206 --> 00:51:29,975
PRODUCT REQUIRES A STABLE

1420
00:51:29,975 --> 00:51:30,609
ACCESSIBLE INFRASTRUCTURE WHERE

1421
00:51:30,609 --> 00:51:34,079
THE PRODUCT CAN BE STORED SAFELY

1422
00:51:34,079 --> 00:51:38,517
AND ADMINISTERED BY TRAINED

1423
00:51:38,517 --> 00:51:40,052
WORKERS.

1424
00:51:40,052 --> 00:51:43,522
LENACAPP A VIR, HAS TO BE GIIVE

1425
00:51:43,522 --> 00:51:45,023
BY 2 SUBCUTANEOUS INJECTIONS

1426
00:51:45,023 --> 00:51:47,392
INTO THE ABDOMEN, IT'S NOT JUST

1427
00:51:47,392 --> 00:51:48,894
SOMETHING YOU JAM INTO

1428
00:51:48,894 --> 00:51:49,261
SOMEBODY'S ARM.

1429
00:51:49,261 --> 00:51:51,263
IN FACT THIS WAS 1 CASE OF A

1430
00:51:51,263 --> 00:51:55,834
PARTICIPANT IN SOUTH AFRICA IN

1431
00:51:55,834 --> 00:52:00,806
THE LENACAP A VIR STUDY, AND HAD

1432
00:52:00,806 --> 00:52:02,174
AN TUMOR NECROSIS BECAUSE THE

1433
00:52:02,174 --> 00:52:03,642
HEALTHCARE WORKER HAD NOT BEEN

1434
00:52:03,642 --> 00:52:04,676
TRAINED ENOUGH IN ADMINISTRATION

1435
00:52:04,676 --> 00:52:06,011
SO THIS IS NOT SOMETHING YOU'RE

1436
00:52:06,011 --> 00:52:07,779
JUST GOING TO BE ABLE TO ROLL

1437
00:52:07,779 --> 00:52:08,213
OFF THE SHELF.

1438
00:52:08,213 --> 00:52:12,584
AND I THINK IT'S NOT -- IT'S

1439
00:52:12,584 --> 00:52:14,519
IMPORTANT TO NOTE THAT PEOPLE

1440
00:52:14,519 --> 00:52:18,423
ARE LIVING IN PLACES WHERE THESE

1441
00:52:18,423 --> 00:52:20,826
INFECTIONS ARE HAPPENING WHERE

1442
00:52:20,826 --> 00:52:23,361
THESE INFRASTRUCTURES ARE REALLY

1443
00:52:23,361 --> 00:52:25,063
THREATENED EVERY SINGLE DAY.

1444
00:52:25,063 --> 00:52:29,701
AND BETWEEN POLITICAL VIOLENCE,

1445
00:52:29,701 --> 00:52:31,103
BETWEEN MILITARY VIOLENCE,

1446
00:52:31,103 --> 00:52:33,505
BETWEEN EVEN CLIMATE CHANGE AND

1447
00:52:33,505 --> 00:52:35,607
CLIMATE DISASTERS TAKING OUT

1448
00:52:35,607 --> 00:52:36,541
THESE INFRASTRUCTURES, THERE'S A

1449
00:52:36,541 --> 00:52:37,275
LOT THAT CAN HAPPEN.

1450
00:52:37,275 --> 00:52:39,010
AND OF COURSE WHEN YOU HAVE

1451
00:52:39,010 --> 00:52:40,745
CONFLICT WHO SUFFERS THE MOST,

1452
00:52:40,745 --> 00:52:41,947
THE MOST VULNERABLE, RIGHT IN SO

1453
00:52:41,947 --> 00:52:44,382
WOMEN IN PARTICULAR, IN CONFLICT

1454
00:52:44,382 --> 00:52:47,385
AFFECTED COUNTRIES ARE

1455
00:52:47,385 --> 00:52:49,254
EXPERIENCING SOME OF THE WORST

1456
00:52:49,254 --> 00:52:49,554
CONDITIONS.

1457
00:52:49,554 --> 00:52:52,257
SO MY POINT HERE IS AGAIN, NOT

1458
00:52:52,257 --> 00:52:54,092
TO BE LIKE GLOOMY, BUT TO SAY,

1459
00:52:54,092 --> 00:52:58,230
THAT WE REALLY NEED TO HAVE 2

1460
00:52:58,230 --> 00:53:02,567
THINGS, 1 MORE CHOICES AND 2, WE

1461
00:53:02,567 --> 00:53:03,568
CAN'T STOP PURSUING DURABLE

1462
00:53:03,568 --> 00:53:04,536
INDIVIDUAL IMMUNITY.

1463
00:53:04,536 --> 00:53:07,672
WE NEED AN HIV VACCINE, WE NEED

1464
00:53:07,672 --> 00:53:09,508
STI VACCINES BECAUSE ALL OF

1465
00:53:09,508 --> 00:53:10,809
THESE OTHER MEASURES AS

1466
00:53:10,809 --> 00:53:12,210
FANTASTIC AS THEY MAY BE AND AS

1467
00:53:12,210 --> 00:53:15,013
GREAT AS THEY MAY BE IN A SINGLE

1468
00:53:15,013 --> 00:53:16,248
COMMUNITY OR SINGLE

1469
00:53:16,248 --> 00:53:17,115
INFRASTRUCTURE OR SINGLE CLINIC,

1470
00:53:17,115 --> 00:53:19,151
ARE NOT GOING TO GET US WHERE WE

1471
00:53:19,151 --> 00:53:23,855
NEED TO BE IN THE PLACES WHERE

1472
00:53:23,855 --> 00:53:25,223
THINGS ARE NOT GETTING BETTER

1473
00:53:25,223 --> 00:53:27,325
AND IN FACT, MAY BE GETTING

1474
00:53:27,325 --> 00:53:28,326
WORSE.

1475
00:53:28,326 --> 00:53:31,897
I ALSO FIND IT SOMETIMES,A

1476
00:53:31,897 --> 00:53:34,032
MAZING THAT I HAVE TO REMIND

1477
00:53:34,032 --> 00:53:37,903
PEOPLE THAT SEXUAL COUNTERS MAY

1478
00:53:37,903 --> 00:53:40,505
BE NOT PLANNED, OR FREQUENT LEER

1479
00:53:40,505 --> 00:53:41,506
CONSENTUAL, IN THAT CASE MAYBE

1480
00:53:41,506 --> 00:53:43,041
YOU DON'T HAVE THE FORETHOUGHT

1481
00:53:43,041 --> 00:53:44,342
OR OPPORTUNITY TO GET TO A

1482
00:53:44,342 --> 00:53:51,349
CLINIC AND LOAD UP ON WHATEVER

1483
00:53:51,349 --> 00:53:52,083
HEMOPROPHYLACTIC WE'RE TALKING

1484
00:53:52,083 --> 00:53:53,518
ABOUT HERE.

1485
00:53:53,518 --> 00:53:57,222
SO I DO THINK THAT ON DEMAND

1486
00:53:57,222 --> 00:54:01,359
PRODUCTS WILL WORK, I JUST HEARD

1487
00:54:01,359 --> 00:54:03,862
TODAY, THAT AND ENROLLED FIST

1488
00:54:03,862 --> 00:54:05,564
FIRST PARTICIPATE, SO THAT'S

1489
00:54:05,564 --> 00:54:07,399
EXCITING PARTICULARLY WHEN YOU

1490
00:54:07,399 --> 00:54:12,170
TALK TO SOME PEOPLE WHO REALLY

1491
00:54:12,170 --> 00:54:13,538
ARE SO STIGMATIZED THAT CAN'T

1492
00:54:13,538 --> 00:54:15,774
GET ORAL PREP AND WE CAN COME

1493
00:54:15,774 --> 00:54:18,810
BACK TO THAT EMPLOY ALSO A NICE

1494
00:54:18,810 --> 00:54:20,478
STUDY RECENTLY BY SHARON RIDDLER

1495
00:54:20,478 --> 00:54:21,980
AND COLLEAGUES LOOKING AT A

1496
00:54:21,980 --> 00:54:26,618
RECTAL INSERT THAT HAS

1497
00:54:26,618 --> 00:54:27,219
TENAFAVIR, AND ADMINISTERED

1498
00:54:27,219 --> 00:54:28,253
RECTIFIEDALLY FOR HIV PREVENTION

1499
00:54:28,253 --> 00:54:29,154
AND THEN THE LAST THINK THIS I

1500
00:54:29,154 --> 00:54:30,855
WILL POINT OUT IS THAT, YOU KNOW

1501
00:54:30,855 --> 00:54:32,157
WE'RE NOT DOING GREAT WITH

1502
00:54:32,157 --> 00:54:33,091
PREVENTION OF VIRTUAL MACHINE

1503
00:54:33,091 --> 00:54:36,895
KRAL TRANSMISSION.

1504
00:54:36,895 --> 00:54:37,529
WE STILL HAVE 160,000 NEW

1505
00:54:37,529 --> 00:54:40,565
PERINATAL INFECTIONS OF HIV IN

1506
00:54:40,565 --> 00:54:41,132
THE WORLD.

1507
00:54:41,132 --> 00:54:44,402
MOST OF THESE ARE IN COUNTRIES

1508
00:54:44,402 --> 00:54:46,137
THAT THERE'S NO PEP FOR, AGAIN

1509
00:54:46,137 --> 00:54:47,906
GETTING BACK TO THE

1510
00:54:47,906 --> 00:54:48,440
INFRASTRUCTURE AND THE

1511
00:54:48,440 --> 00:54:49,774
COMMITMENT TO HAVE A SUSTAINED

1512
00:54:49,774 --> 00:54:52,410
PRESENCE AND DELIVER THESE

1513
00:54:52,410 --> 00:54:53,011
PRODUCTS.

1514
00:54:53,011 --> 00:54:55,046
SO, IT'S -- IT'S -- I LOVE TO

1515
00:54:55,046 --> 00:54:58,283
THINK ABOUT THE MAGIC OF CHEMO

1516
00:54:58,283 --> 00:55:00,585
PROPHYLAXIS, I LOVE TO THINK

1517
00:55:00,585 --> 00:55:02,053
ABOUT THE POTENTIAL, BUT I JUST

1518
00:55:02,053 --> 00:55:04,189
DON'T WANT PEOPLE TO GET SO

1519
00:55:04,189 --> 00:55:05,757
CAUGHT UP IN THIS CONCEPT THAT

1520
00:55:05,757 --> 00:55:09,027
ALL WE HAVE TO DO, IS GET IT

1521
00:55:09,027 --> 00:55:10,762
APPROVED TO GET IT TO PEOPLE.

1522
00:55:10,762 --> 00:55:12,230
THE OTHER THING IS NOT EVERYBODY

1523
00:55:12,230 --> 00:55:13,765
WANTS A SHOT AND NOT EVERYBODY

1524
00:55:13,765 --> 00:55:15,200
WANTS A PILL, NOT EVERYBODY

1525
00:55:15,200 --> 00:55:17,035
WANTS A GEL, RIGHT?

1526
00:55:17,035 --> 00:55:20,272
PEOPLE REALLY DO NEED CHOICE AND

1527
00:55:20,272 --> 00:55:21,773
I JUST AGAIN, ANOTHER PLEA, THIS

1528
00:55:21,773 --> 00:55:24,976
IS SOMETHING I ALSO WANT TO

1529
00:55:24,976 --> 00:55:28,346
POINT OUT IS THAT IF WE DON'T

1530
00:55:28,346 --> 00:55:29,347
INCLUDE PREGNANT AND BREAST

1531
00:55:29,347 --> 00:55:31,016
FEEDING WOMEN IN PARTICULAR IN

1532
00:55:31,016 --> 00:55:32,651
THESE STUDIES, THEN WE'RE NOT

1533
00:55:32,651 --> 00:55:34,786
REALLY GOING TO MAKE A DENT

1534
00:55:34,786 --> 00:55:35,754
PARTICULARLY IN PREVENTING

1535
00:55:35,754 --> 00:55:36,888
VERTICAL TRANSMISSION AND THIS

1536
00:55:36,888 --> 00:55:39,758
IS JUST A NICE SLIDE THAT I GOT

1537
00:55:39,758 --> 00:55:40,625
FROM LISA [INDISCERNIBLE], WHO

1538
00:55:40,625 --> 00:55:44,195
IS THE DIRECTOR OF THE JOHNS

1539
00:55:44,195 --> 00:55:47,432
HOPKINS INTERNATIONAL PREGNANCY

1540
00:55:47,432 --> 00:55:48,833
NG O, LOOKING AT AND POINTING

1541
00:55:48,833 --> 00:55:53,104
OUT THAT WE HAVE REASSURING DATA

1542
00:55:53,104 --> 00:55:55,507
FOR TEGAVIR, AND LENACAPP A VIR,

1543
00:55:55,507 --> 00:56:00,345
AND 1 THING ABOUT THESE STUDIES

1544
00:56:00,345 --> 00:56:01,413
THEY DIDN'T EXCLUDE THEM FROM

1545
00:56:01,413 --> 00:56:03,915
BEING ON A HORMONAL

1546
00:56:03,915 --> 00:56:06,418
CONTRACEPTIVE WHICH IS A REMNANT

1547
00:56:06,418 --> 00:56:08,653
MATERIAL IN STUDIES WE HAVE DONE

1548
00:56:08,653 --> 00:56:09,421
IN THE PAST.

1549
00:56:09,421 --> 00:56:11,356
SO THEY HAVE A NUMBER OF WOMEN

1550
00:56:11,356 --> 00:56:12,657
PREGNANT ON THESE STUDIES AND

1551
00:56:12,657 --> 00:56:14,926
THEY WILL BE A GOLD MINE FOR

1552
00:56:14,926 --> 00:56:16,828
INSURING THAT THESE WILL BE

1553
00:56:16,828 --> 00:56:17,395
GIVEN SAFELY IN PREGNANCY.

1554
00:56:17,395 --> 00:56:19,631
SO I THINK IT'S JUST GOING TO BE

1555
00:56:19,631 --> 00:56:21,166
IMPORTANT TO CONTINUE TO

1556
00:56:21,166 --> 00:56:23,902
PRIORITIZE THEM, NOT JUST IN

1557
00:56:23,902 --> 00:56:24,703
STUDIES OF [INDISCERNIBLE] BUT

1558
00:56:24,703 --> 00:56:26,137
IN ALL THESE STUDIES.

1559
00:56:26,137 --> 00:56:28,707
SO I SHOULD SAY THAT THIS SLIDE

1560
00:56:28,707 --> 00:56:31,142
IS TRUE FOR STI VACCINES AS

1561
00:56:31,142 --> 00:56:31,710
WELL.

1562
00:56:31,710 --> 00:56:33,945
THIS WHOLE CONCEPT OF DURABLE

1563
00:56:33,945 --> 00:56:34,846
INDIVIDUAL IMMUNITY IS A PLACE

1564
00:56:34,846 --> 00:56:36,081
WE HAVE TO GET TO.

1565
00:56:36,081 --> 00:56:38,483
WE NEED TO THINK ABOUT HIGHLY

1566
00:56:38,483 --> 00:56:39,751
EFFECTIVE VACCINES BUT EVEN IF

1567
00:56:39,751 --> 00:56:41,252
WE DON'T HAVE HIGHLY EFFECTIVE

1568
00:56:41,252 --> 00:56:42,687
VACCINES, WE MAY GET VACCINES

1569
00:56:42,687 --> 00:56:44,089
THAT ARE LOOKING AT THESE

1570
00:56:44,089 --> 00:56:46,424
MODELS, MIGHT BE ENOUGH TO BUY

1571
00:56:46,424 --> 00:56:47,058
US SOME TIME.

1572
00:56:47,058 --> 00:56:50,662
AND WE DO HAVE NEW MANUFACTURING

1573
00:56:50,662 --> 00:56:52,263
PLATFORMS, LIKE MRNA PLATFORMS

1574
00:56:52,263 --> 00:56:53,665
THAT COULD GIVE US WAYS THAT WE

1575
00:56:53,665 --> 00:56:55,066
COULD GET THIS OUT THERE FASTER

1576
00:56:55,066 --> 00:56:59,270
AND STUDY IT FASTER WITH IDEALLY

1577
00:56:59,270 --> 00:56:59,904
SURROGATE MARKER PROTECTION, SO

1578
00:56:59,904 --> 00:57:01,873
AND THEN I THINK THE INNOVATIONS

1579
00:57:01,873 --> 00:57:03,475
AND TRIAL DESIGNS FOR THOSE WHO

1580
00:57:03,475 --> 00:57:06,878
DESIGN TRIALS, AND STUDIES, THE

1581
00:57:06,878 --> 00:57:09,314
BIOSTATISTICIANS GIVEN THE

1582
00:57:09,314 --> 00:57:11,216
LENACAPP A VIR RESULTS, THIS IS

1583
00:57:11,216 --> 00:57:12,117
GETTING INTERESTING EMPLOY HOW

1584
00:57:12,117 --> 00:57:13,651
WILL WE STUDY AN HIV VACCINE,

1585
00:57:13,651 --> 00:57:15,387
HOW WILL WE STUDY AN HIV VACCINE

1586
00:57:15,387 --> 00:57:17,021
WHEN YOU HAVE TO OFFER PEOPLE

1587
00:57:17,021 --> 00:57:19,057
THE STANDARD OF CARE WHICH IS

1588
00:57:19,057 --> 00:57:22,694
NOW IS PREP AND IN THE BEST CASE

1589
00:57:22,694 --> 00:57:24,195
SCENARIO PREVENTS HIV INFECTION,

1590
00:57:24,195 --> 00:57:25,897
SO I'LL LIVE YOU WITH THAT.

1591
00:57:25,897 --> 00:57:27,732
BECAUSE I CAN'T ANSWER THAT.

1592
00:57:27,732 --> 00:57:29,167
JUST SAY THANK IF YOU ARE YOUR

1593
00:57:29,167 --> 00:57:37,942
ATTENTION AND WOULD LOVE TO HEAR

1594
00:57:37,942 --> 00:57:42,380
YOUR THOUGHTS.

1595
00:57:42,380 --> 00:57:42,747
[ APPLAUSE ]

1596
00:57:42,747 --> 00:57:45,717
NTHANK YOU FOR A VERY THOUGHTFUL

1597
00:57:45,717 --> 00:57:46,251
AND THOROUGH PRESENTATION.

1598
00:57:46,251 --> 00:57:49,421
I THINK WE HAVE TIME FOR 1 OR 2

1599
00:57:49,421 --> 00:57:52,123
QUESTIONS HERE BEFORE WE CLOSE.

1600
00:57:52,123 --> 00:57:56,060
>> DOCTOR, I WOULD LIKE TO
ADD A

1601
00:57:56,060 --> 00:57:57,195
CAVEAT ABOUT THE DOXY-PEP STORY

1602
00:57:57,195 --> 00:57:59,230
IS THAT IS WE HAVE ENCOURAGING

1603
00:57:59,230 --> 00:58:01,433
DATA FROM YEAR 1 BUT MY CONCERN

1604
00:58:01,433 --> 00:58:03,868
IS YEARS 2, 3, 4, 5.

1605
00:58:03,868 --> 00:58:05,837
THESE PEOPLE NEED PROTECTION

1606
00:58:05,837 --> 00:58:06,337
EVERY YEAR.

1607
00:58:06,337 --> 00:58:09,507
>> YEAH NAND WHAT WE
LEARNED

1608
00:58:09,507 --> 00:58:14,412
FROM THE TENOFAVIR STORY IS THAT

1609
00:58:14,412 --> 00:58:19,684
COMPLIANCE WITH PREEXPOSURE FOR

1610
00:58:19,684 --> 00:58:21,219
TENOFAVIV, AND IT GOES DOWN WITH

1611
00:58:21,219 --> 00:58:23,388
TIME AND OVER TIME AND GOES DOWN

1612
00:58:23,388 --> 00:58:25,290
WITH DOXY-PEP THAT WE MAY SEE A

1613
00:58:25,290 --> 00:58:27,492
DIFFERENT RESULT IN SUBSEQUENT

1614
00:58:27,492 --> 00:58:28,593
YEARS.

1615
00:58:28,593 --> 00:58:30,662
>> I COULD NOT AGREE MORE
WHICH

1616
00:58:30,662 --> 00:58:32,797
IS WHY I KEEP BRINGING UP THAT

1617
00:58:32,797 --> 00:58:34,532
WORD DURABLE, I DON'T THINK PREP

1618
00:58:34,532 --> 00:58:36,167
IS A DURABLE STRATEGY, I'M

1619
00:58:36,167 --> 00:58:39,637
PROBABLY OUT THERE IN SAYING

1620
00:58:39,637 --> 00:58:45,176
THAT IT'S NOT A DURABLE STRATEGY

1621
00:58:45,176 --> 00:58:46,144
AT A COMMUNITY LEVEL BECAUSE OF

1622
00:58:46,144 --> 00:58:48,813
THE CONCERNS I RAISED AROUND

1623
00:58:48,813 --> 00:58:49,280
ANTIBIOTIC RESISTANCE.

1624
00:58:49,280 --> 00:58:53,918
YOU KNOW WE'RE NOT SEEING

1625
00:58:53,918 --> 00:58:55,053
CHLAMYDIA RESISTANT DOXY-PEP

1626
00:58:55,053 --> 00:58:56,921
RESISTANCE, IT'S A CELLULAR

1627
00:58:56,921 --> 00:58:58,189
ORGANISM, IT'S AN ORGANISM

1628
00:58:58,189 --> 00:59:00,525
THAT'S NOT KNOWN TO EVOLVE

1629
00:59:00,525 --> 00:59:02,193
RESISTANCE, WE'RE NOT SEEING

1630
00:59:02,193 --> 00:59:03,428
RESISTANT SYPHILIS, BUT YOU

1631
00:59:03,428 --> 00:59:04,662
NEVER KNOW WITH SYPHILIS, I

1632
00:59:04,662 --> 00:59:05,964
WOULD NEVER COULD YOU WANT IT

1633
00:59:05,964 --> 00:59:06,130
OUT.

1634
00:59:06,130 --> 00:59:09,334
IT'S A NERVE WRACKING PATHOGEN.

1635
00:59:09,334 --> 00:59:10,368
ANY OTHER QUESTIONS, ANY

1636
00:59:10,368 --> 00:59:12,270
QUESTIONS ONLINE YOU WANTED TO

1637
00:59:12,270 --> 00:59:12,637
MENTION?

1638
00:59:12,637 --> 00:59:14,005
>> WE DON'T HAVE ANY
QUESTIONS

1639
00:59:14,005 --> 00:59:15,073
COMING IN.

1640
00:59:15,073 --> 00:59:16,407
>> OKAY, WELL, THANK YOU
FOR

1641
00:59:16,407 --> 00:59:17,041
YOUR ATTENTION, I REALLY

1642
00:59:17,041 --> 00:59:19,844
APPRECIATE IT AND THANKS.

1643
00:59:19,844 --> 00:59:30,088
[ APPLAUSE ]