Has anyone seroconverted while on PrEP?

[HereInLondon]

From an article published yesterday analysing drug concentrations at seroconversion, 6 of 31 seroconverters had blood concentrations consistent with steady-state daily adherence. Their estimate of protection, with daily dosing, is 91%. Nothing in there about 100% protection when going wild at sex parties!

Is this the article you're referring to? - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059553/

I found the jargon of the article a bit difficult to understand, but the third last and second last paragraphs of the Discussion section talk about the occurrence of high blood concentrations and reported daily adherence and looking at possible explanations for seroconversion in those instances.

And overall the article is very positive about PrEP (tho the study seems to have been about heterosexual men and women).

[rawfuckr]

From an article published yesterday analysing drug concentrations at seroconversion, 6 of 31 seroconverters had blood concentrations consistent with steady-state daily adherence. Their estimate of protection, with daily dosing, is 91%. Nothing in there about 100% protection when going wild at sex parties!

You can peruse through the article carefully, and you'll see that they are just looking at the drug level free floating in the blood. It is a known fact that TDF/FTC drug levels in blood are NOT a good indicator of how good someone is taking the drug. The real levels that matter are the levels of TDF inside the cells (PBMC levels) and sadly this study didn't measure those. There are many reasons why this study could be showing people seroconverting with high levels in blood. For example, the while coat effect, where the participant takes the pill just the day before the study visit but he's not a good adherer. Also, TDF levels seem to peak rapidly in blood, you reach high levels in a mere hours after taking the pill, but it takes up to 7 days to get into strong protective levels in PBMC cells. High levels in blood can't really tell you that much about adherence other than the person took it recently.

iPrEX did do PBMC testing in a subset of the study participants. That's when some smart folks decided to take neg folks people and having them take the pill on-site 2,4, and 7 times per week. No questions about adherence here. Then measured their TDF PBMC levels (http://goo.gl/kCY3zp) and compared to those observed in iPrEX. It's from this study that the now famous 'Truvada is 99% effective' quote comes from. This is still an 'after the fact' study, but iPrEX has looked at effectivity from different angles and pretty much all of them reach the +90% mark with daily dosing. Something overlooked is that just having even the minimum detectable level of TDF in blood would yield +90% effectivity. If I recall they can detect TDF even taken 2 weeks before, so its remarkable that just having some of it in your system would decrease your chances so much.

In all, it just 'seems' PrEP is very effective to stop HIV transmission. If its 90-99% even on daily adherers, we just don't know with certainty, and thus the original question. I think only time will tell.

[SFCumdog]

Have there been any outcomes reported for people who achieve daily adherence, and whom have sex with poz guys who adhere daily and are undetectable?

[rawfuckr]

Have there been any outcomes reported for people who achieve daily adherence, and whom have sex with poz guys who adhere daily and are undetectable?

The study in europe is sort of looking into this. Just having the poz guy be undetectable has so far conferred complete protection for the negative partner even if they were not on PrEP. If you add PrEP to the mix, it just seems impossible that anyone would seroconvert if poz is undetectable on drugs and neg is on PrEP.

[Poz1956]

Have there been any outcomes reported for people who achieve daily adherence, and whom have sex with poz guys who adhere daily and are undetectable?

The simple answer is "No," and there likely never will be research like that.

The only way to ethically study HIV transmission is long term follow-up of serodiscordant (serodifferent, magnetic, Poz/Neg) couples. The Partner study was the first to look at condomless sex when the Pozzie has an undetectable viral load. It was also the first study to include enough gay couples to produce statistically significant results. In the first two years of the study, none of the negative partners, gay or straight, caught HIV from their Poz spouse. There were roughly 16,400 gay BB fucks (and 28,000 straight ones), with no transmissions. During this study all of the conditions occurred, that people warn might make a Pozzie infectious (Colds, Flu, Vaccinations, STIs, a few missed doses of ARVs for up to 4 days), yet there will still no cases where the Poz partner passed on the virus.

Partner2 is adding about 450 more gay couples (dropping the straight ones) and continuing 2017. I think they are aiming for around 100,000 gay BB fucks by the end. There is also a similar study underway in Australia. Opposites Attract will publish its findings in 2017

For a study of the effectiveness of combining viral load with PrEP, we would first have to establish that undetectable Pozzies CAN transmit the virus. It would need to happen with high enough frequency to test the protective abilities of Truvada.

I for one (and pretty much everybody else [except condom manufacturers]) hope there are zero transmissions from the undetectable Pozzies in Partner2 and Opposites Attract.

With the current data on PrEP and Undetectable Viral Loads, a study of their combined effects would seem to be an unnecessary waste of money and resources. It would be like studying the efficacy of Condoms + PrEP.

Edited July 3, 2014 by Poz1956

[Guest kazore]

I just read a message on the poz forum of a guy who got pozed while on Prep

This is not a good news. Should we think twice before engaging bareback sex now?

 

Here is the message:

 

 

http://forums.poz.com/index.php?PHPSESSID=c8fr5pn7evgd931l5f3k9veps6&topic=58527.0

 

I began taking Truvada to prevent HIV infection in the summer of 2014. I last tested negative Nov. 3, 2014. I was religiously adherent--I only missed a few doses when I was first taking Truvada. I did put myself at risk though on an occasion and I know that while very effective, Truvada isn't failsafe. About a week after a risk episode in January 2015, I was very ill for about two weeks. I had chills, night sweats, and a horrible cough when it was done. The flu was rampant at the time so I didn't really think much of it.

My next visit/check up was on February 13, 2015. I didn't hear anything for weeks, but on March 26 was notified by my doctor's office that I had tested positive on an ELISA and a Western Blot (my doctor was apparently on vacation when the results came in, hence the delay). I went in the next day to get a CD4 count, RNA count, and genetic testing as I was told it was virtually certain I had HIV. It took nearly a week to get the results from the lab, and it turned out the lab only ran the CD4 count, which was 564. So I went in again for the RNA/gene test. In the mean time, I just wanted some closure, so I bought an Oraquick test, which came back negative. I notified my doctor, and he said to hang on and we'd see what the RNA test results were. Two days later, the results still weren't in, so I took another Oraquick that I bought from a different retailer, which also was negative. I began to suspect a lab mix-up due to the low odds of two false positives on the Oraquick and a Truvada failure, and my doctor said he was inclined to agree with me.

Two days later I received a call from him--the RNA test was very low, at 540 (too low to do a gene test). He said he had consulted with the HIV specialist at the clinic he works at (a large, prestigious hospital), and they both were fairly certain (high 90s) that it was a lab mixup and the RNA test was a false positive.

So I then went in for another RNA test as well as two new 4th gen tests. After another week of waiting, with the hope that I was negative, April 17 (yesterday) I received another call from my physician. I came up positive on one of the tests, inconclusive on the other, and with a viral load of 1030, still very low. But this time the doctor said he is certain I now have HIV. He and the HIV specialist are uncertain why my viral load is so low--they think either I might be a long-term non-progressor, which is hard to ascertain at this point in time, or that the Truvada had somehow delayed the typical viral load progression or made it less severe.

I am now awaiting results for a gene test. The doctor and HIV specialist are highly recommending immediate treatment. However, I read the debate about early treatment initiation on this website (and read the original published articles). I found the scientific arguments for delayed treatment to be far more compelling, especially given that it is possible I could be a long-term non-progressor, I am inclined to closely monitor viral load and CD4 counts before jumping into the decision. Another factor is the strain could possibly be Truvada-resistant, which might limit my options for the "gentler" treatment regimens.

At any rate, it has been an emotional rollercoaster to say the least for the past 3 weeks. I am actually feeling OK with the fact that I'm positive. My life isn't over, but my life as I knew it is. Thankfully, the science has advanced so much where I can expect to still live a healthy life. I do wonder if perhaps I am "making a molehill out of a mountain." At this point, I will just wait for the genetic testing and then go from there I suppose.

Any words from the wise, especially from anyone who may have tested positive despite being on Truvada, would be appreciated! I am sorry for such a long posting, but I decided to err on the side of being thorough.

[Guest Seattlebottom]

Call me skeptical, but there is something about this post from the other forum that doesn't seem right.  From what I have read (and I've read a lot) and from the researchers I've spoken with, taking Prep every day is pretty much 100% effective against HIV.  While nothing in life is 100%, I am just not sure how much of this guy's post is true.  Again, perhaps I'm just being skeptical, but what doctor's office what allow at 6 week delay in getting information to a patient (especially when this is such important information) even if the doctor was on vacation?  9 times out of 10 there is another healthcare provider covering for someone who is on vacation, and I can't imagine a doctor not informing someone covering for him that he has a patient who would be very anxious to receive results.  Also, he says he missed a few doses at the beginning of his Truvada experience, but doesn't really address the overall time period he has taken it, or, for that matter, his overall health in general.  He states that he "put himself at risk" - exactly when was this "risk" situation?  With so many crackpots on the Internet (and I'm not saying this guy is one of them), I think one has to be really careful what one believes when reading something.  All of what this man says could be true (although extremely rare) and he is just one of the very rare individuals for which Truvada didn't work, or he could be one of those people wanting to scare individuals taking Prep (they're out there).  When reading the follow-up conversations on this post it appears that others are questioning him, too.  Although this poster gives a lot of information, a lot of it is also inconclusive and that's what leads me to question him.

 

What I think this means for all of us is to keep reading, and to stay on top of our own health.  Even the CDC (the most conservative of all healthcare organizations) has not spoken of any conversions (that I'm aware of) of someone religiously sticking to his Truvada medication.

[justabitnastycub]

It takes a lot of drunk urge for me to post this but, I am on prep and I still dream of a daddy making me positive. Please don't flag me I mean this!

[Guest kazore]

Call me skeptical, but there is something about this post from the other forum that doesn't seem right.  From what I have read (and I've read a lot) and from the researchers I've spoken with, taking Prep every day is pretty much 100% effective against HIV.  While nothing in life is 100%, I am just not sure how much of this guy's post is true.  Again, perhaps I'm just being skeptical, but what doctor's office what allow at 6 week delay in getting information to a patient (especially when this is such important information) even if the doctor was on vacation?  9 times out of 10 there is another healthcare provider covering for someone who is on vacation, and I can't imagine a doctor not informing someone covering for him that he has a patient who would be very anxious to receive results.  Also, he says he missed a few doses at the beginning of his Truvada experience, but doesn't really address the overall time period he has taken it, or, for that matter, his overall health in general.  He states that he "put himself at risk" - exactly when was this "risk" situation?  With so many crackpots on the Internet (and I'm not saying this guy is one of them), I think one has to be really careful what one believes when reading something.  All of what this man says could be true (although extremely rare) and he is just one of the very rare individuals for which Truvada didn't work, or he could be one of those people wanting to scare individuals taking Prep (they're out there).  When reading the follow-up conversations on this post it appears that others are questioning him, too.  Although this poster gives a lot of information, a lot of it is also inconclusive and that's what leads me to question him.

 

What I think this means for all of us is to keep reading, and to stay on top of our own health.  Even the CDC (the most conservative of all healthcare organizations) has not spoken of any conversions (that I'm aware of) of someone religiously sticking to his Truvada medication.

possibly but poz forum is a serious forum, the post is well detailed. Why would someone write a fake post? Truvada could be the reason of a low viral load.

[drscorpio]

It takes a lot of drunk urge for me to post this but, I am on prep and I still dream of a daddy making me positive. Please don't flag me I mean this!

This sort of comment belongs in the Backroom part of the forum, if you are trying to be encouraged in these thoughts.

If you are looking for help dealing with unwanted feelings, let me know, and I will split your post off into it's own thread.

In either case, let's try not to get sidetracked in this thread.

[nekofox]

I just read a message on the poz forum of a guy who got pozed while on Prep

This is not a good news. Should we think twice before engaging bareback sex now?

 

Here is the message:

 

 

http://forums.poz.com/index.php?PHPSESSID=c8fr5pn7evgd931l5f3k9veps6&topic=58527.0

 

I began taking Truvada to prevent HIV infection in the summer of 2014. I last tested negative Nov. 3, 2014. I was religiously adherent--I only missed a few doses when I was first taking Truvada. I did put myself at risk though on an occasion and I know that while very effective, Truvada isn't failsafe. About a week after a risk episode in January 2015, I was very ill for about two weeks. I had chills, night sweats, and a horrible cough when it was done. The flu was rampant at the time so I didn't really think much of it.

My next visit/check up was on February 13, 2015. I didn't hear anything for weeks, but on March 26 was notified by my doctor's office that I had tested positive on an ELISA and a Western Blot (my doctor was apparently on vacation when the results came in, hence the delay). I went in the next day to get a CD4 count, RNA count, and genetic testing as I was told it was virtually certain I had HIV. It took nearly a week to get the results from the lab, and it turned out the lab only ran the CD4 count, which was 564. So I went in again for the RNA/gene test. In the mean time, I just wanted some closure, so I bought an Oraquick test, which came back negative. I notified my doctor, and he said to hang on and we'd see what the RNA test results were. Two days later, the results still weren't in, so I took another Oraquick that I bought from a different retailer, which also was negative. I began to suspect a lab mix-up due to the low odds of two false positives on the Oraquick and a Truvada failure, and my doctor said he was inclined to agree with me.

Two days later I received a call from him--the RNA test was very low, at 540 (too low to do a gene test). He said he had consulted with the HIV specialist at the clinic he works at (a large, prestigious hospital), and they both were fairly certain (high 90s) that it was a lab mixup and the RNA test was a false positive.

So I then went in for another RNA test as well as two new 4th gen tests. After another week of waiting, with the hope that I was negative, April 17 (yesterday) I received another call from my physician. I came up positive on one of the tests, inconclusive on the other, and with a viral load of 1030, still very low. But this time the doctor said he is certain I now have HIV. He and the HIV specialist are uncertain why my viral load is so low--they think either I might be a long-term non-progressor, which is hard to ascertain at this point in time, or that the Truvada had somehow delayed the typical viral load progression or made it less severe.

I am now awaiting results for a gene test. The doctor and HIV specialist are highly recommending immediate treatment. However, I read the debate about early treatment initiation on this website (and read the original published articles). I found the scientific arguments for delayed treatment to be far more compelling, especially given that it is possible I could be a long-term non-progressor, I am inclined to closely monitor viral load and CD4 counts before jumping into the decision. Another factor is the strain could possibly be Truvada-resistant, which might limit my options for the "gentler" treatment regimens.

At any rate, it has been an emotional rollercoaster to say the least for the past 3 weeks. I am actually feeling OK with the fact that I'm positive. My life isn't over, but my life as I knew it is. Thankfully, the science has advanced so much where I can expect to still live a healthy life. I do wonder if perhaps I am "making a molehill out of a mountain." At this point, I will just wait for the genetic testing and then go from there I suppose.

Any words from the wise, especially from anyone who may have tested positive despite being on Truvada, would be appreciated! I am sorry for such a long posting, but I decided to err on the side of being thorough.

 

 

From looking a bit into the actual thread of the post and all, it seems like he's the 1% chance where it could happen, so in a way, it's not a common occurrence.   Another thing that kind of popped up in my personal belief is how he admitted that he did lax at first, so that could have been an "open window" for him to be infected.  As much as we mostly know about how if one gets the "fuck flu", we also have to keep in mind that not all will have the same symptoms at first or ever.

 

So, in short, it's still a good viable option for PrEP, but just like those who do use condoms or (for those of us that are bi and also like to be with women), those who use birth control, it's never, NEVER going to be 100%.  The chance of something going wrong is definitely slim, but doesn't mean it won't happen.  

[seaguy]

I wouldn't put it past some of the anti PrEP crowd to post fake blog posts claiming to have gotten infected while on PrEP in a pathetic attempt to try and undermine PrEP and it's use.

[BiAggieGuy]

It could be someone just bullshiting, a lie of the anti-PrEP/anti-bareback crowd, or it could be true.

Nothing is 100% certain and effective. While PrEP greatly reduces the risk, I'm sure every expert will say there is always the possibility, however slight, of still being pozzed.

I'm on PrEP and have been taking poz loads since being on it, and am still neg. However, I accept that there is always that slight chance, but it is probably far, far less than playing with random guys without being on PrEP.

[Pitt1988]

So the guy that that posted about getting infected while on PREP posted a new response today, im a little confused as to what he said; he's stating that he contracted a strain that is resistant to PREP? how would someone come in contact with such a strain? ugh i hope there's more to this story here's his post:

 

My gene testing results are in. It now makes sense why Truvada failed despite 100% adherence. The virus that I have is resistant to emtricitabine, one of Truvada's ingredients. I am not resistant to Tenofovir, the other ingredient, which my doctor thinks is why my viral load is so low (1000) even after an estimated 3 months of infection. 

It also turns out the virus I have is resistant to lamivudine and rilpivirine, and is possibly resistant against didanosine. It looks like this is going to greatly limit the medications I can use since most of the "gentler" treatment options contain lamivudine, ripulviriene, and/or or emtriciatabine. I'm pretty terrified about it right now. 

I'm awaiting another CD4/viral load result and then have plans to see the HIV-specialist my doctor has been consulting with. I'm also thinking of seeing another HIV specialist for a second opinion on treatment (both what and when). 

If you know anyone taking Truvada, please let them know not to rely on it exclusively. There are mutations of the virus out there resistant to the two drugs in Truvada.

[rawfuckr]

So the guy that that posted about getting infected while on PREP posted a new response today, im a little confused as to what he said; he's stating that he contracted a strain that is resistant to PREP? how would someone come in contact with such a strain? ugh i hope there's more to this story here's his post:

 

My gene testing results are in. It now makes sense why Truvada failed despite 100% adherence. The virus that I have is resistant to emtricitabine, one of Truvada's ingredients. I am not resistant to Tenofovir, the other ingredient, which my doctor thinks is why my viral load is so low (1000) even after an estimated 3 months of infection. 

It also turns out the virus I have is resistant to lamivudine and rilpivirine, and is possibly resistant against didanosine. It looks like this is going to greatly limit the medications I can use since most of the "gentler" treatment options contain lamivudine, ripulviriene, and/or or emtriciatabine. I'm pretty terrified about it right now. 

I'm awaiting another CD4/viral load result and then have plans to see the HIV-specialist my doctor has been consulting with. I'm also thinking of seeing another HIV specialist for a second opinion on treatment (both what and when). 

If you know anyone taking Truvada, please let them know not to rely on it exclusively. There are mutations of the virus out there resistant to the two drugs in Truvada.

 

You have to take a load from someone who is unmedicated and with high VL. Sounds a long stretch.

 

Case looks legit, but he mentions that "I was very ill for about two weeks. I had chills, night sweats, and a horrible cough when it was done. The flu was rampant at the time so I didn't really think much of it."  Given his VL was so low <1000 it's just hard to picture why would anyone would have a fuck-flu when they are essentially undetectable.  Either he's a phenonemal Bullshitter or just the first known case to get infected while on PrEP.