It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens.
The question is whether all humans can produce this, or just some genotypes. If it's the latter, then yes, some people would have to take it as medicine and never stop.
> then yes, some people would have to take it as medicine and never stop.
Which is a problem since it would probably be a monoclonal antibody and those are the most expensive drugs to make. Like hundreds of thousands or even millions per year expensive (depending on what dose is needed).
If it really does cost millions per year the US couldn't afford it - it would cost over a trillion per year to treat everyone in the US, and more than 40 trillion to treat everyone (and that's just for the medicine).
(For comparison total healthcare spending in the US is 3 trillion.)
So better hope that either the price goes down, or that it only requires a limited course of treatment. Can you imagine a cure for HIV, and we can't afford it?
What are the reasons behind such prohibitive cost? Rare expertise, advanced factories, amount of time required, lack of economy-of-scale, monopoly, something else?
If the cure is proven, the society will likely be able to mobilize much more resources, particularly to scale up operations.
Special expertise can be trained to other biologists (the underemployment problem would be mitigated as well). More biologists could be trained. Likewise for factories, materials, etc. Monopolies can be broken.
What factors cannot be scaled up with such an approach? (Honest question. I do not know anything about antibody production.)
> What are the reasons behind such prohibitive cost? Rare expertise, advanced factories, amount of time required, lack of economy-of-scale, monopoly, something else?
The first 3. Monopoly doesn't help I'm sure, but this drug class in inherently very expensive to produce, there's a reason there is little outcry over the prices charged.
It's extremely labor intensive, and very hard to scale up. They are also inherently dangerous, so there is a need for extreme purity. (See: https://en.wikipedia.org/wiki/TGN1412 for what a monoclonal antibody can do, you would not want that to happen by accident.)
As of right now this drug class remains the most expensive of all drugs, I would assume if it were possible to make it cheaper they would have.
But we'll only really know once the first generics enter the market.
It's curious, because in the near future monoclonal antibodies, as produced by your own body, should be the very cheapest 'drugs' (sic; read 'therapy' or 'cure') to make. If your own body is the manufacturing plant, it's just the cost of delivering the blueprints, once (very cheap).
You design the monoclonal antibody, figure out its sequence, deliver the sequence back into your own body (via some HIV-like virus), and now your body has an unlimited continuous access to the therapeutic.
Production of the therapeutic-delivering virus could be done in such a way as to produce a global scale for a small amount of money that would never need to be administered again. For example, in lab I can produce enough (lab quality) purified protein for a single one-time dose for a few thousand dollars and a week's work. On the other hand, I could produce enough therapeutic virus for dozens of people to forever produce their own versions of that same protein for a few hundreds dollars and an afternoon's work. This is very unlike any other 'drug' of the 20th century.
> It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens.
Ahh, of course they do. Thanks for the clarification :)
What you've described is a similar concept to what immunologists call Vectored Immunoprophylaxis (VIP). VIP has been used effectively in vaccination and treatment of HIV in mouse models [1], and primate trials are ongoing. Essentially this approach entails delivering the gene encoding for an antibody (for example N6 from this paper) directly in a viral vector to cells in the body. This process completely bypasses the traditional physiological vaccination and antibody selection process which may fail to produce a useful antibody such as N6. Instead, the antibody is directly expressed, and secreted from cells that the viral vector infected. Because we know the delivered antibody is effective at targeting the pathogen, these antibodies enable the immune system to home in on the virus in a deterministic way.
This is very reasonable. Technically, today, it is a bit of a challenge to ensure it gets delivered in such a way as to not hurt more than it helps, and to ensure it remains active. But at this point that kind of auto-manufacturing of a therapeutic an 'engineering problem' rather than a 'scientific problem'.
as an aside: Curiously, in the lab at least, most of those therapies are delivered using a 'gutted' version of HIV (precisely because it is so good at delivering genetic payloads to humans). So there's a pretty good chance you'd be using an engineered version of HIV's own machinery to deliver a permanent anti-HIV payload to the patient's genome.
The question is whether all humans can produce this, or just some genotypes. If it's the latter, then yes, some people would have to take it as medicine and never stop.