Man On Daily Prep Regimen Contracts Hiv

[topstud127]

The first case of HIV contraction in a person taking PrEP (pre-exposure prophylaxis, or a antiretroviral drug cocktail used to protect people from contracting HIV) daily has been documented and presented by David Knox, MD, an HIV specialist at the Maple Leaf Medical Clinic, at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, according to Benjamin Ryan at Poz. Ryan reports:

Evidence suggests that the individual in question, a 43-year-old man who has sex with men, adhered well to PrEP over the long-term. Nevertheless, after 24 months on Truvada he tested positive for HIV. Initial tests indicated that he was acutely (very recently) infected: He tested positive for the p24 antigen, which appears within about three weeks of HIV infection and disappears a few weeks afterward; and at that time he tested negative for HIV antibodies, which typically appear two to eight weeks after infection.

 

 

PrEP Fails in Gay Man Adhering to Daily Truvada, He Contracts Drug-Resistant HIV

Researchers have for the first time documented an individual contracting multi-drug-resistant HIV…

Read more poz. com

And furthermore:

 

“After 32 years of experience with HIV research, I have learned never to say ‘never’,” said Robert M. Grant, MD, MPH, a professor at the University of California, San Francisco, who was the head of the iPrEx trial that first proved PrEP’s effectiveness among MSM and transgender women in 2010. “Yet I also think that gay men benefit from feeling safer during sex, and I am grateful that PrEP affords that feeling.”

Pharmacy records indicated that the man in the case study had consistently filled his Truvada prescription on schedule. Dried blood-spot testing on a sample taken 16 days after he tested positive for HIV indicated that he had adhered well to Truvada during the previous one to two months, a period that overlapped with the estimated time when he contracted the virus.

“This person claims he was taking PrEP every day and I believe him,” said Grant.

The man tested positive for a strain of the virus that was resistant to multiple drugs, including emtricitabine and tenofovir, which make up Gilead’s Truvada, the current antiretroviral cocktail on the market that’s used as PrEP. Poz adds, “Despite all these resistance mutations, the man in the case study is currently taking HIV treatment and has a fully suppressed viral load.” And also:

What is more rare is a virus that is highly resistant to both tenofovir and emtricitabine, as in this new case report. Indeed, according to Grant, among more than 9,200 participants in the clinical trials of PrEP, such a virus that was highly resistant to both components of Truvada was never seen.

The takeaway is that PrEP is not 100 percent effective, as many hoped it was. That doesn’t mean that it’s ineffective (its efficacy has been estimated by some to be as high as 99 percent), it just means that like virtually everything, it is not the perfect, absolute solution to the HIV epidemic. Antiretrovirals are incredibly powerful tools in curbing the spread of HIV—a study of hundreds of sero-different couples amounting to tens of thousands of condomless sexual encounters found not one instance of transmission of HIV from the positive partner to the negative.

Also presented at the conference was the CDC’s estimation that PrEP has the potential to reduce new infections in the United States by 70 percent, according to the Advocate.

And while this PrEP news is sobering, it’s far from the most sobering HIV-related headline of the week. That honor goes to the CDC’s estimation that if rates continue as they are, one in two black men who have sex with men will contract HIV in his lifetime. Fifty percent. For a variety of reasons, that population is particularly underserved when it comes PrEP and HIV treatment as a whole.

 

http://gawker.com/man-on-daily-prep-regimen-contracts-hiv-according-to-s-1761282343

https://www.poz.com/article/prep-fails-gay-man-adhering-daily-truvada-contracts-drugresistant-hiv

[rawfuckr]

TL;DR

 

Guy on PrEP with good adherence contracts multi-drug resistant HIV strain. Infection is caught right away and guy is now UD with his current regimen.

Edited February 25, 2016 by rawfuckr

[Guest SecretCumWhore]

Damn.... someone's load was so charged, PreP didn't stand a chance.  

[nastybottom]

I was afraid of this. I didn't think it would happen this soon.

[BiAggieGuy]

It was inevitable that it would happen. There is nothing in this world that is a 100% certainty other than death, taxes, and politicians lying.

[FTLBBversbttm]

So the question is, given one report, do you pull back from a medically approved mitigant?  Do you completely change behavior?  Hmmm.  Not sure.

[tboyer]

Also a member of this forum reported a failure of Prep in spite of adherence. One could say that the reported failures are very few this being the only one, but how many failures haven't been reported? Still it seems that Prep gives some protection. I think one should accept that if one has anal intercourse one might convert. For most people with access to medication and healthcare being HIV + is not the end of the world, and there are many things that are worse. For me, having strangers shoot their loads into me is worth being poz

[Pitt1988]

Im very confused regarding this case; they are saying the individual lives in Toronto, Canada, and was on PREP for 24 months; first of all PREP is not even approved in Canada for preventive use; how is it possible someone in Canada has been on PREP for 24 months? It would make more sense if it was an American case...?

[Guest Porthos]

This appears to be an incredibly rare case where the guy was infected with a strain of HIV resistant to both the drugs in Truvada....as the article states...among more than 9,200 participants in the clinical trials of PrEP, such a virus that was highly resistant to both components of Truvada was never seen.

 

Seems incredibly rare....stick with PrEP and have fun

[bearbandit]

More on this at http://www.thebodypro.com/content/77164/hiv-infection-despite-prep-6-things-providers-and-.html

I believe that truvada-as-PrEP has been available off-label in Canada for a while. It's also possible that the guy concerned was importing his own generic TDF/FTC (Tenvir-Em or similar) with the support of his doctor.

 

This is the first and ONLY documented incidence of failure of adherent truvada use to prevent HIV infection. As indicated by the article I've linked to, the mutation is very rare, and the HIV+ guy must have had a fairly high viral load to be infectious at all (remember that even with a VL above infectious levels, the chance of transmission is still only 1.4% - HIV remains very difficult to catch). There probably have been a few, and I mean a few as in three or four at most, other seroconversions in guys using truvada, but these haven't been documented in such meticulous detail as this one: the others remain, for scientific purposes, undocumented, essentially hearsay or garden-fence gossip. 

 

More than the 9,200 trial participants: add in the participants in trials other parts of the world (not everything happens in the USA!), everybody taking truvada-as-PrEP officially (tens of thousands in the USA alone), and everybody who's making their own private arrangements to import generic truvada. In the UK we (PrEP activists) know of 16 clinics who are prepared to do the necessary bloodwork for people who are importing generic truvada and the call has just gone out to get people to ask if their STI clinic would help out.

 

The fact that this guy is now doing well on ARVs is proof that even with resistances to drugs, there are all but certainly other drugs that can replace the ones the mutated virus is resistant to. Indeed if that weren't the case, I wouldn't be typing this as I'm resistant or allergic to practically everything in the pharmacy: indeed by coincidence my prescription is very similar to the Toronto guy's.

 

Basically, what I'm trying to do here is put this story into context: if you're taking or considering PrEP, please carry on/go ahead and don't worry about it: you're more likely to be in a multi-vehicle pile-up and get struck by lightning than have PrEP fail in this manner.

[seaguy]

It's never been stated to be 100% effective either.

 

I would like to know a little more about the guy and his partners was he a bathhouse whore or grindr slut?

[Pitt1988]

I wonder if he seroconverted bottoming for a high viral load? Im primarly a top; but ive been really excited about going fully vers once im on prep; its still a mistery to me if tops are at the same risk as bottoms at this point.

[disorder]

Probably similar to being infected via oral. Even the case where the neg partner in lesbian relationship was infected. Very rare.

[Pitt1988]

Yes i heard about the lesbian case; but there was blood involved, and lots of it; that was the main reason.

[topstud127]

I wonder if he seroconverted bottoming for a high viral load? Im primarly a top; but ive been really excited about going fully vers once im on prep; its still a mistery to me if tops are at the same risk as bottoms at this point.

 

I don't remember the statistic, but tops are at a far lessor risk than bottoms. Possible, but far less likely hence you see so many tops with no issue topping bare and never catch anything compared to bottoms.