Source
r/hivaids•
ebek

Supply chain issues and ARVs

So, the global supply chain issues seem to be exacerbating. I try to keep at least six months worth of my meds (Biktarvy) at home at all times so hopefully I'll be able to weather a storm but still, I am interested to know the details of how I am kept alive. Specifically:

Which ingredients are required to produce its components (bictegravir, emtricitabine and tenofovir alafenamide)? Where are these sourced today? Are there any particularly complicated or costly steps in the synthesis process? And so on.

The same answers for other popular drugs/combinations would be interesting too.

Or just pointers to where I can start the research myself.

Uncomfortable question maybe but I think it's good that we start talking about this. Thank you very much in advance for any constructive input you may have, no matter how small!

Posted Sep 25, 2021, 7:49 AM UTC · edited

820
Chase_Online•

I’m not sure how other people get theirs, but I get a 90 day supply at a time, then twice randomly my doc gave me some free samples, so even when my Rx is about to refill, I still have like a 20ish day supply before I open my 90 day.

In order for the Rx supply chain to go down that badly, there would need to be a doomsday scenario that most people wouldn’t want to live through anyways.

Short of meteor/zombies/nuke/King Kong, the drug supply is strong.

6
Spain_iS_pain•

I am also interested in this point.

2
crumblingbees•

if yr in america, there's no supply chain issues and no reason to think there's gonna be.

u sound like a paranoid prepper.

if you don't even know enough about these medicines to figure out their manufacturing processing, or the possible substitutions, yr not in any position to be determining the likelihood of future supply issues. u would need a real thorough understanding of synthetic chemistry to understand both the manufacture and all the alternative ways of getting to same final product if a particular chemical became unavailable.

if there are ever serious supply issues with arvs, it'll be the least of our problems.

even with coronavirus and the biggest disruptions to manufacturing in modern times, there were no arv supply issues here. if they'd allowed panic hoarding of arvs like they did toilet paper, maybe there would've been short term shortages. but they didn't.

the types of calamities that would render america unable to provide arvs to its peeps are black swan events, impossible to predict bcuz the likelihood is too low and impossible to calculate. but the type of calamities that would render america unable to provide arvs to its people for any length of time are so calamitous that the lack of arvs would be the least of our problems.

2
ebekOP•

if yr in america

I'm not, but thank you for assuming I guess?

Most of your reply is completely nonconstructive and beside the point. I don't want to get into those off-topic discussions, but I'll address the one point that you did make:

if you don't even know enough about these medicines to figure out their manufacturing processing, or the possible substitutions, yr not in any position to be determining the likelihood of future supply issues. u would need a real thorough understanding of synthetic chemistry to understand both the manufacture and all the alternative ways of getting to same final product if a particular chemical became unavailable.

This is certainly mostly true, which is exactly why I try to start researching it. I could see the semiconductor crisis coming months before it was talked about in major media outlets, despite not knowing anything about their fairly involved production process. How? Because here's the part you are missing: It is very possible to learn the relevant info about very many fields if you are willing to read things with an open mind, think both critically and creatively, apply some process of elimination and other common-sense heuristics, ask experts for specific explanations/info, and make implicit connections explicit. You will naturally never become an expert in this way but you'd be surprised how far you'll get to understanding the parts that you actually care about.

If you think this seems crazy, fine. I'm not here to convince anyone. I'm literally just looking for information and find that Reddit is often a good place to start digging, given the amount of knowledgeable people who hang out here. If you're not one of them (or if you are, but simply don't want to help), I don't see what you're doing in this thread?

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1
OneLastTime0804•

never heard or read a news about medicine supply chain issues. chips yes. can you provide a link?

1
ebekOP•

Ok just a few quick links to back up my other response:

2
ebekOP•

Afaik there are no specific issues surrounding medicines, at least not yet. But there are plenty of issues with supply chains more generally and chips are basically just the most well-known example – shipping costs skyrocketing, Pennsylvania rationing alcohol, lumber shortage earlier this year, shortage of coal and oil, probably more that I'm forgetting. And I could easily see the Evergrande liquidity crunch sending further shockwaves throughout the global economy. You should be able to verify all of these rather easily but I'll try to remember to dig up links when I get home.

To which degree all of these are connected and how/if they or a potential common cause could spill over to pharmaceuticals can of course be debated, but that's not what I'm looking to do here. I'm simply observing that there are widespread issues and want to get informed – partly so that I can answer the question of a possible spillover for myself.

0
Alarmed-Water-4959•

If you live in any Western countries, there will not be a shortage of ARVs because they are using treatment as a form of preventing new infections. Even if you are a chemist or a pharmacist, it will be difficult to make these pills on your own with proper efficacy. When I was in college, they taught us how to synthesis aspirin and a few other simple products and we had to go through many many steps and the final products were not good enough to consume. I do not think it is a good idea to get preoccupied thinking about impossible.

1
ebekOP•

Even if you are a chemist or a pharmacist, it will be difficult to make these pills on your own with proper efficacy. [...] I do not think it is a good idea to get preoccupied thinking about impossible.

Yeah this is fair enough, but I'm not really aspiring to do that. More that if I conclude that shit does seem to be about to hit the fan, I would look into importing generics from some country with less restrictions, to complement what I'm allow to take out here. Thanks for the concern though, it's certainly a valid one.

2
Alarmed-Water-4959•

I think India and Thailand provide the generic version of Biktarvy for less than $100 per month. You can look into it.

1
ebekOP•

Yeah they would be my go-to as well. Thanks a lot for the input! :)

1
Alarmed-Water-4959•

I do not think it is a good idea to hoard on any ARVs because every two years they come up with new and better formulas. They approved once a month injection now and soon biktarvy might be available in the injectable form as well. If you live in any Western countries, you will have access to the most modern ARVs. They might come up with immunotherapy for treatments. Many trials are going on around the world to treat HIV more effectively. Stick with 1-3 months supplies and you will be fine.

2
NeenW1•

You’re being paranoid and in no way would you ever be able to get these ingredients a d many of us can only get 30 day supply at most so if you have 6 months what are you worried about???

1
ebekOP•

read the other comments lol 🤦‍♂️

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[deleted]•

[removed]

-3
zblake10•

Have you ever had unprotected sex? Even once? Because regardless of the low risk, it happens. Many who are infected with HIV aren't drug addicts or hypersexual. It can happen to anyone. PREP is a great tool for those of us who are sexually active and at increased risk. I've taken such drugs for several years for peace of mind. To suggest irresponsibility as a reason for someone to aquire HIV is not only rude but very misinformed.

3
estr3lla90•

Didn't your family teach you to keep silent if you have nothing constructive to say?

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