Has anyone seroconverted while on PrEP?

[makingwords]

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

 

Does that really sound like a stretch? Lots of guys are unmedicated. I'm sure most of the "not sure" and "I don't care" status guys on BBRT are infected and unmedicated. When you're taking multiple loads at a sex party how would you know who is medicated and who is not?

 

If true, this is a pretty alarming incident for neg guys on PrEP such as myself.

[Pitt1988]

That is exactly what i am thinking makingwords; all these years ive drove myself nuts asking questions such as are u tested, are you neg, blah blah even when i used condoms; the last thing i need is to be popping a pill everyday and asking; are u neg or poz? Are u on meds, undetectable or dont know? Not to forget a study just concluded that you do indeed lose bone density in the first 6 months on truvada; so now not only do i have bone loss, but have to worry about high viral loads? However; there is something off about this story, so i wont draw any conclusions just yet

[Guest Seattlebottom]

Just thought I would respond to Pitt1988 about the bone density question.  I have osteoporosis and my doctor and I both discussed the possibility of the bone density loss with Truvada.  In the end we decided we would try and in 6 months test my bone density again to see if there was any (or a substantial loss) in bone density.  Perhaps I am just lucky, but after my bone scan done last month it showed no more loss of density so, needless to say, I am very happy about that.  From what I've read it is a possibility (not a given0 of bone density loss and, perhaps, I just got lucky.  We are going to test again in 6 months to see if it remains the same.

 

Since I am the one who sort of started this by questioning the validity of the poster, I want to again say that I understand that the forum where he posted is a respected forum, but since no one here knows this person personally, I always feel that it's best to question things that you've read on the Internet.  Perhaps it's true, but perhaps not.  For me personally, I feel the best response to this would be to keep researching and I definitely intend to bring this up to my doctor at my next appointment to see if she has heard anything of any conversions after taking Prep. 

 

We can be afraid of so many things in life and, really all we can do is protect ourselves the best we can (including becoming as knowledgeable as possible) and then live life to the fullest.  I had a terrible motorcycle accident a few years ago and, yet I am still riding my motorcycle - taking a few more precautions than I used to :-)  I think the same way about Prep - it doesn't mean I don't take precautions and continue to read up on the latest news, but I also don't want to be afraid of things any more - too many years of that.

 

I can only speak for myself here and the nice thing about this forum is that I have learned a great deal which has helped me tremendously as I chart my sexual life with Prep.  A lot of really knowledgeable and nice people here.

[Pitt1988]

Hi Seattlebottom thanks for your insight; if you have osteoporosis and are on PREP and suffer no bone loss; thats really great news! Im glad for you and you helped put my mind at ease about that issue; because if you havent suffered bone loss and you already have osteoporosis; then that means the bone loss from PREP is very rare, and youre right we dont know what really happened with the poster's situation; so ill just go on taking my PREP and living fearless for a change

[drscorpio]

I have a friend who converted from being fucked with a condom by a fuckbuddy who believed he was neg. It turned out that the guy had converted since his recent negative HIV test, and that the condoms were out of date. He had not noticed that and apparently the rubber leaked rather than obviously breaking. He most likely converted from another of the old condoms failing.
It sounds like this guy had a similar "perfect storm" of circumstances that led to PrEP not protecting him. It doesn't mean PrEP isn't 90+% effective. It just a sign that sometimes you end up being the exception and not the rule.

[curiousaboutbb]

http://www.aidsmeds.com/articles/PrEP_drug_resistance_1667_26703.shtml

This article appears to be talking about a similar thing. Two subjects converted on prep study. The strain they had was resistant to the emtricitabine. They seemed to think they developed resistance. I wonder if ther were just like the guy in the post being discussed. I am on truvada and it is a little unnerving.

For the first time, a study has shown that, although rare, resistance to Truvada (tenofovir/emtricitabine) can develop if someone contracts HIV while taking the drug as pre-exposure prophylaxis (PrEP). In previous studies this had only been found to occur if someone turned out to be acutely, or very newly, infected with HIV when they started taking PrEP. (An HIV test may yield a false negative if conducted during an acute infection, possibly leading someone to enter a PrEP study under the false impression that he or she does not have the virus.)

Publishing their findings in the Journal of Infectious Diseases, researchers analyzed plasma samples from the 121 study participants who contracted HIV in the Partners PrEP Study. They tested the samples for HIV that had resistance mutations associated with emtricitabine or tenofovir. The study was a Phase III, randomized, double-blind, placebo-controlled trial in which the HIV-negative member of 4,747 mixed-HIV status heterosexual couples was assigned to receive Truvada or tenofovir as PrEP, or a placebo.

Out of those who tested HIV positive during the study, 25 were assigned Truvada, 38 were assigned tenofovir and 58 were assigned the placebo. Drug levels in the plasma indicated that 26 participants had taken PrEP during or after acquiring the virus. Out of this group, five people had evidence of resistance mutations associated with their PrEP regimen: four of seven (57 percent) of those who took Truvada, and one of 19 (5.3 percent) who took tenofovir. The difference in resistance rates between the two groups was the result of the development of the emtricitabine-related resistance mutation M184IV.

Of the five participants who had drug resistance, three were found to have been acutely infected when they started the trial, leaving two people who were HIV-negative when they enrolled. These two people are key, because their cases indicate that there is a possibility of contracting HIV while taking PrEP and then developing drug resistance, although this chance is apparently rare.

The authors state that that risk of drug resistance may be higher in those who are taking PrEP around the time that they are infected and in those who, because of infrequent follow-up testing, take PrEP for an extended period after contracting the virus. Truvada as PrEP is highly effective if taken daily as prescribed, but loses efficacy if taken less frequently. U.S. Food and Drug Administration protocol recommends that people taking PrEP undergo HIV testing every three months. The participants in this study were tested monthly.

The study found that resistance was more likely to develop to the emtricitabine component of Truvada, meaning that only taking tenofovir instead of Truvada, which also emtricitabine in addition to tenofovir, would lower the risk of resistance. However, the authors state that this risk must be weighed against the 49 percent increased efficacy of Truvada over tenofovir as PrEP that was found in the Partners study.

In an accompanying editorial, Robert M. Grant, MD, MPH, a professor at the University of California, San Francisco, who led the iPrEx study that proved PrEP’s efficacy among men who have sex with men (MSM) in 2010, and Teri Liegler, PhD, an associate professor at UCSF, write, “Fear of drug resistance is now raised as we consider rolling out PrEP.” However, they add, “Fomenting fear of drug resistance is also misguided if it distracts us from fear of HIV itself, by far the greater threat to human health.”

[rawfuckr]

Does that really sound like a stretch? Lots of guys are unmedicated. I'm sure most of the "not sure" and "I don't care" status guys on BBRT are infected and unmedicated. When you're taking multiple loads at a sex party how would you know who is medicated and who is not?

 

If true, this is a pretty alarming incident for neg guys on PrEP such as myself.

 

Guys who dont know they are infected don't have med resistant strains, are therefore they will be stopped readily by PrEP. I should look it up, but seems med-resistant strains are not virulent. Add the two, and the case of being infected by someone who's carrying Truvada-resistant HIV sounds very implausible.

The biggest problem by far with PrEP is starting it while having just serocoverted. This could very well be the case recently hitting the news; guy didn't get RNA tests on baseline and could have been infected. Antibody test went negative for a while while he was a few months on PrEP and eventually he developed resistance to the drug... If you go on PrEP demand RNA tests, a couple or three weeks apart, while you are starting. You do want a solid negative baseline.

 

http://www.aidsmeds.com/articles/PrEP_drug_resistance_1667_26703.shtml

This article appears to be talking about a similar thing. Two subjects converted on prep study. The strain they had was resistant to the emtricitabine. They seemed to think they developed resistance. I wonder if ther were just like the guy in the post being discussed. I am on truvada and it is a little unnerving.

 

This one has been talked about before. The big thing for us to notice here, is that these people were straight, and likely women. For women TDF concentrations in the vaginal area are orders of magnitude less than in rectum, therefore more prone to seroconversions. Also It can't be established how well adherent the people who serocoverted were. They were definitely taking it sometimes but there could have been gaps, we don't know.

[BiAggieGuy]

I'd say right now, we don't know enough or have enough data to know if they got it while on PrEP, got it just before starting, or if there is another factor(s) (missed doses, IV drug use, etc.) involved.

 

Regardless, nothing is full proof so there are always risks no matter what.  To expect PrEP to be 100% effective is completely foolish.  However, it is still far safer than random hookups with guys without any protection.

[Guest kazore]

why don't they propose a prep regimen with 3 components and not only 2?

[rawfuckr]

why don't they propose a prep regimen with 3 components and not only 2?

 

Side-effects and cost. If you are HIV+ you are going to put up with side effects just because you have to, but for prevention the side-effect profile really needs to be very favorable. There's also the cost issue.

[tallbtm]

Truvada was chosen initially to test as a PrEP drug partly because it has such a low incidence of side effects. It's well tolerated by almost everyone and has been used for years as a component of HIV-treatment combinations. But in the future, it's likely not going to be the only drug choice for PrEP.

 

There are other drugs and delivery methods in the pipeline that are being tested for use as PrEP. For example, here's an article today about testing an injection that could provide protection for 12 weeks: http://betablog.org/injectable-prep-the-next-order-of-the-day/

 

As time goes on, there will be other options. Right now, Truvada is the only approved PrEP drug. And it's highly effective.

[bearbandit]

To my mind, people who refuse to take PrEP on the basis of the one or two cases where someone has seroconverted and no lapse can be found in their adherence, or any other explanation, must have great difficulty even getting to their local shop. They're far more likely to be in a road traffic accident than to catch HIV while taking PrEP properly. Or hit by lightning. Or <insert your own choice of almost certainly fatal disaster here>.

I took tenofovir along with a couple of other antivirals for about eight years, and it was only through the negligence of my doctor that I ended up seriously ill (a 1 in 100,000 chance) because of tenofovir. Doesn't stop me recommending it to others, though. I was just plain damn unlucky. And the good news for guys on PrEP is that tenofovir comes out of patent in 2017, and emtricitabine around the same time, which, of course, means that the price will fall as generics come onto the market.

 

And as tallbtm says other drugs are being tested for their potential as PrEP. Personally I'm betting that the next drug is an integrase inhibitor, maybe with an NRTI, because the integrase inhibitors have shown a remarkable degree of tissue penetration and an extremely low side effect profile...

[wood]

To my mind, people who refuse to take PrEP on the basis of the one or two cases where someone has seroconverted and no lapse can be found in their adherence, or any other explanation, must have great difficulty even getting to their local shop. They're far more likely to be in a road traffic accident than to catch HIV while taking PrEP properly. Or hit by lightning. Or <insert your own choice of almost certainly fatal disaster here>.

 

exactly.

 

And assuming the story is true, who exactly is shocked by this!?!?  Almost nothing in life is 100%, and PrEP surely isnt.  However, neither are most vaccines, other medical treatments, etc.  Hell the effective rate of the HEP A/B vaccine is something like 97-98% yet we dont even think about that anymore.  I know PrEP isnt 100% but taken correctly its still a lot more effective than the highest estimate effective rate of condoms at 93%.  

 

Even if the story is fake, there will be more cases of people converting while on PrEP.  Many will be from people who are not taking it correctly, but some will be from strains that sneak bye.  It sucks but thats life, and it doesnt change the fact that PrEP is still hugely effective. 

[nekofox]

exactly.

 

And assuming the story is true, who exactly is shocked by this!?!?  Almost nothing in life is 100%, and PrEP surely isnt.  However, neither are most vaccines, other medical treatments, etc.  Hell the effective rate of the HEP A/B vaccine is something like 97-98% yet we dont even think about that anymore.  I know PrEP isnt 100% but taken correctly its still a lot more effective than the highest estimate effective rate of condoms at 93%.  

 

Even if the story is fake, there will be more cases of people converting while on PrEP.  Many will be from people who are not taking it correctly, but some will be from strains that sneak bye.  It sucks but thats life, and it doesnt change the fact that PrEP is still hugely effective. 

 

That's the main point through and through.  I'm still surprised at how much of people are on the mindset that anything dealing with medicine is going to be 100%, when unfortunately, it's not.  Even the most routine of situations can have dire consequences due to simple bad luck.   A lot of people I've heard about or known have had their fair share of said bad luck where thankfully they're still around, or unfortunately have passed on (an ex girlfriend of mine passed from heart complications, after hearing how the hospital she was at had been questionable).  So realistically, to be on something like PrEP, it's basically worth using it if you plan to stay NEG.  The chance of even becoming POZ is REALLY low, but that doesn't mean it won't happen, just gotta take the precaution of for your own mindset.  

 

Main thing through and through, if you ever have doubts, then don't do it, otherwise, go and have fun.